Provider Demographics
NPI:1215005137
Name:LUPTON, GEORGE PASCHAL (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PASCHAL
Last Name:LUPTON
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 1:606 STEPHEN SITTER AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1290
Mailing Address - Country:US
Mailing Address - Phone:301-295-5252
Mailing Address - Fax:301-295-5675
Practice Address - Street 1:606 STEPHEN SITTER AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1290
Practice Address - Country:US
Practice Address - Phone:301-295-5252
Practice Address - Fax:301-295-5675
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10113207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC101133Medicaid
B91631Medicare UPIN