Healthcare Provider Details

I. General information

NPI: 1609363829
Provider Name (Legal Business Name): RUPAK KUMAR BHUYAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 06/13/2025
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HARRISBURG PIKE SUITE 370
LANCASTER PA
17601-3200
US

IV. Provider business mailing address

2150 HARRISBURG PIKE SUITE 370
LANCASTER PA
17601-3200
US

V. Phone/Fax

Practice location:
  • Phone: 717-399-8790
  • Fax: 717-399-3279
Mailing address:
  • Phone: 717-399-8790
  • Fax: 717-399-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-49577
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD-49577
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: