Provider Demographics
NPI:1568271294
Name:KUPRADZE, VASIL
Entity type:Individual
Prefix:MR
First Name:VASIL
Middle Name:
Last Name:KUPRADZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TASHKENTI STREET
Mailing Address - Street 2:
Mailing Address - City:TBILISI
Mailing Address - State:TBILISI
Mailing Address - Zip Code:00000
Mailing Address - Country:GE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 VAZHA-PSHAVELA AVENUE
Practice Address - Street 2:
Practice Address - City:TBILISI
Practice Address - State:TBILISI
Practice Address - Zip Code:00000
Practice Address - Country:GE
Practice Address - Phone:995-322-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program