Provider Demographics
NPI:1326198672
Name:UPP, JUSTIN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOHN
Last Name:UPP
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 PROVIDENCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1468
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-749-5819
Practice Address - Street 1:752 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3425
Practice Address - Country:US
Practice Address - Phone:704-873-5651
Practice Address - Fax:704-749-5819
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-09-16
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Provider Licenses
StateLicense IDTaxonomies
NC2014-00034207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI247AMedicare PIN