MEDICARE: BOBBY NOUPA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1225738370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY NOUPA

Provider Business Mailing Address
First Line	:	2041 MARTIN LUTHER KING JR AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7024
Country	:	US
Telephone Number	:	202-547-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 MARTIN LUTHER KING JR AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-7024
Country	:	US
Telephone Number	:	202-547-4850
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	05/18/2026

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Directions to “ BOBBY NOUPA ” Practice Location

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