Provider Demographics
NPI:1063412153
Name:MA, YUPO (MD PHD)
Entity type:Individual
Prefix:
First Name:YUPO
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICAL CTR
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8691
Mailing Address - Country:US
Mailing Address - Phone:631-444-2241
Mailing Address - Fax:631-444-1566
Practice Address - Street 1:STONY BROOK MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8691
Practice Address - Country:US
Practice Address - Phone:631-444-2241
Practice Address - Fax:631-444-1566
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257066207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101447Medicare PIN
NYH75351Medicare UPIN