Provider Demographics
NPI:1538276472
Name:KRUPITZER, THOMAS R (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:KRUPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:STE. 1C
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-721-5700
Mailing Address - Fax:330-721-5798
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:STE. 1C
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-721-5700
Practice Address - Fax:330-721-5798
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY231575207Q00000X
MDD0066659207Q00000X
OH90339207Q00000X
VA0101241476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4640Medicare ID - Type Unspecified
NYI14761Medicare UPIN