Provider Demographics
NPI:1215099759
Name:LUPPENS, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:LUPPENS
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 1:101 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6952
Mailing Address - Country:US
Mailing Address - Phone:410-749-9290
Mailing Address - Fax:410-543-9087
Practice Address - Street 1:101 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6952
Practice Address - Country:US
Practice Address - Phone:410-749-9290
Practice Address - Fax:410-543-9087
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022099207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT6990004OtherCAREFIRST BLUE CHOICE
20886OtherMAMSI
MD961001400Medicaid
DE0000090501Medicaid
VA006340709Medicaid
MD331190OtherCAREFIRST BCBS
4410364OtherAETNA
MDT6990004OtherCAREFIRST BLUE CHOICE
MD961001400Medicaid
20886OtherMAMSI
180011935Medicare ID - Type UnspecifiedRAILROAD