Provider Demographics
NPI:1295401107
Name:KULPA, JEFFREY DAVID (PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:KULPA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 JAMBARD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6521
Mailing Address - Country:US
Mailing Address - Phone:603-521-5345
Mailing Address - Fax:
Practice Address - Street 1:31 JAMBARD RD
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NH
Practice Address - Zip Code:03049-6521
Practice Address - Country:US
Practice Address - Phone:603-521-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program