Provider Demographics
NPI:1194929869
Name:LUPINETTI, ALLISON DAWN (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DAWN
Last Name:LUPINETTI
Suffix:
Gender:F
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:PO BOX 8836
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0836
Mailing Address - Country:US
Mailing Address - Phone:518-262-5575
Mailing Address - Fax:518-262-5184
Practice Address - Street 1:35 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3420
Practice Address - Country:US
Practice Address - Phone:518-262-5575
Practice Address - Fax:518-262-5184
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244139207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02902298Medicaid
NY244190OtherLICENSE
NY244190OtherLICENSE