MEDICARE: RALPH H UPCHURCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	47671	MA

General Provider Information

NPI Number	:	1154498889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH H UPCHURCH MD

Provider Business Mailing Address
First Line	:	230 HIGHLAND AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1408
Country	:	US
Telephone Number	:	617-591-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 HIGHLAND AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1408
Country	:	US
Telephone Number	:	617-591-4707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/18/2012

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