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General NPI Number Information
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NPI Number | 1275663833
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Entity Type | Individual
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Provider Name | MICHAEL D RUPP M.D., F.A.C.C.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 166 HANOVER ST SUITE 305
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City | WILKES BARRE
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State | PA
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Zip | 18702-3549
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Country | US
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Telephone | 570-826-6875
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Fax | 570-829-2280
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Provider Business Mailing Address
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Address Line | 166 HANOVER ST SUITE 305
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City | WILKES BARRE
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State | PA
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Zip | 18702-3549
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Country | US
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Telephone | 570-826-6875
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Fax | 570-829-2280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD042006E
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License Number State | PA
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