1609849512 NPI number — STEFAN A DUPONT M.D.

Table of content: STEFAN A DUPONT M.D. (NPI 1609849512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609849512 NPI number — STEFAN A DUPONT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPONT
Provider First Name:
STEFAN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609849512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20800 HARVARD RD
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
HIGHLAND HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-7251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3909 ORANGE PL
Provider Second Line Business Practice Location Address:
STE 2300
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-285-5041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  35-094899 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3041550 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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