MEDICARE: KEVIN R KUPFERER MPAS

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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1066587	OTHER		PHYSICIAN ASSISTANT

General Provider Information

NPI Number	:	1336133164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R KUPFERER MPAS

Provider Business Mailing Address
First Line	:	7700 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2929
Country	:	US
Telephone Number	:	703-681-8090
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	02/28/2014

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