MEDICARE: DR. ROBERT CHUPELLA PHD

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	103T00000X	Psychologist	PS003385L	PA

General Provider Information

NPI Number	:	1720088172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHUPELLA PHD

Provider Business Mailing Address
First Line	:	540 BRIDLE PATH RD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-3110
Country	:	US
Telephone Number	:	610-691-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 E ELIZABETH AVE
Second Line	:	SUITE 27
City	:	BETHLEHEM
State	:	PA
Zip	:	18018-6505
Country	:	US
Telephone Number	:	610-691-1740
Fax Number	:	610-691-1740

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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