Provider Demographics
NPI:1063417178
Name:LUPOLD, CHRIS PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:PAUL
Last Name:LUPOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 HARTMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RONKS
Mailing Address - State:PA
Mailing Address - Zip Code:17572-9508
Mailing Address - Country:US
Mailing Address - Phone:717-925-8469
Mailing Address - Fax:717-983-4722
Practice Address - Street 1:334 HARTMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RONKS
Practice Address - State:PA
Practice Address - Zip Code:17572
Practice Address - Country:US
Practice Address - Phone:717-925-8469
Practice Address - Fax:717-983-4722
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064589Medicaid
VA241168OtherSOUTHERN HEALTH/COVENTRY
VA137120OtherBLUE CROSS / BLUE SHIELD
VA11432096OtherCAQH
VA0101236029OtherSTATE MEDICAL LICENSE
VA2269661OtherCIGNA
VA75960OtherCHIR / OPTIMA
VA75960OtherCHIR / OPTIMA
I06490Medicare UPIN
VA2269661OtherCIGNA
VA010064589Medicaid