=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477515369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAUL H LUPIA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 07/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 MALCOLM BLVD
-----------------------------------------------------
City | VALDESE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-237-3378
-----------------------------------------------------
Fax | 843-237-5073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8801 BLUFF POINTE CT
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-676-9819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 9400906
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 01042330A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------