Provider Demographics
NPI:1356383442
Name:KUPFER, MENDEL (MD)
Entity type:Individual
Prefix:
First Name:MENDEL
Middle Name:
Last Name:KUPFER
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 1:2093 PHILADELPHIA PIKE # 5845
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2424
Mailing Address - Country:US
Mailing Address - Phone:215-435-2500
Mailing Address - Fax:802-335-3933
Practice Address - Street 1:675 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2426
Practice Address - Country:US
Practice Address - Phone:215-435-2500
Practice Address - Fax:802-335-3933
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426860208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101723780Medicaid
PA101723780Medicaid
PA061941EFUMedicare PIN