Healthcare Provider Details

I. General information

NPI: 1063417178
Provider Name (Legal Business Name): CHRIS PAUL LUPOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 HARTMAN BRIDGE RD
RONKS PA
17572
US

IV. Provider business mailing address

334 HARTMAN BRIDGE RD
RONKS PA
17572-9508
US

V. Phone/Fax

Practice location:
  • Phone: 717-925-8469
  • Fax: 717-983-4722
Mailing address:
  • Phone: 717-925-8469
  • Fax: 717-983-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD422618
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: