Provider Demographics
NPI:1073509618
Name:CUPO, WILLIAM WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:CUPO
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:P.O. BOX 1150
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1150
Mailing Address - Country:US
Mailing Address - Phone:304-264-1000
Mailing Address - Fax:304-264-1374
Practice Address - Street 1:2500 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:304-264-1374
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054071207P00000X
FLME86389207P00000X
WV23763207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA280056058CMedicaid
FL2671298-00Medicaid
FLP00675117Medicare PIN
FL2671298-00Medicaid
FL79496YMedicare PIN