Healthcare Provider Details

I. General information

NPI: 1346578697
Provider Name (Legal Business Name): PAMELA LUPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST FL 4
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

1 BAYLOR PLZ NEUROLOGY DEPT
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-3695
  • Fax:
Mailing address:
  • Phone: 713-798-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberP3384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: