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General NPI Number Information
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NPI Number | 1558369645
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Entity Type | Individual
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Provider Name | SANDRA H. PUPA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 11/09/2013
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Provider Practice Location Address
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Address Line | 1730A 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4140
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Country | US
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Telephone | 601-703-4395
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Fax | 601-703-4394
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Provider Business Mailing Address
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Address Line | PO BOX 908
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City | MERIDIAN
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State | MS
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Zip | 39302-0908
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Country | US
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Telephone | 601-703-4282
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Fax | 601-703-4597
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 13753
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License Number State | MS
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