Provider Demographics
NPI:1528047701
Name:LUPKAS, RAYMOND R JR (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:LUPKAS
Suffix:JR
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:PO BOX 890178
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0178
Mailing Address - Country:US
Mailing Address - Phone:706-860-2701
Mailing Address - Fax:
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8708
Practice Address - Country:US
Practice Address - Phone:910-215-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401442207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC050041120OtherRR MEDICARE
NC75933OtherMEDCOST
NC8953257Medicaid
NC53257OtherBCBS OF NORTH CAROLINA
SCN60874Medicaid
NC2207168Medicare PIN
NC53257OtherBCBS OF NORTH CAROLINA
NC050041120Medicare PIN