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NPI Code Detail

MEDICARE: DR. KEITH R RUPPEL M.D.

MEDICARE: DR. KEITH R RUPPEL M.D.
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
12080A0000XPediatric Adolescent Medicine Physician78845MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962499269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH R RUPPEL M.D.
Provider Business Mailing Address
First Line : 15 VREELAND AVE
Second Line :
City : EAST LONGMEADOW
State : MA
Zip : 01028-1631
Country : US
Telephone Number : 413-787-2555
Fax Number : 413-787-9992
Provider Business Practice Location Address
First Line : 15 VREELAND AVE
Second Line :
City : EAST LONGMEADOW
State : MA
Zip : 01028-1631
Country : US
Telephone Number : 413-787-2555
Fax Number : 413-787-9992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2005
Last Update Date : 12/13/2011

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