Provider Demographics
NPI:1548291610
Name:KUPERSCHMIT, MARCELO (MD)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:KUPERSCHMIT
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:403
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-717-4300
Practice Address - Fax:703-717-4301
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033221174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710036611Other874231
VA7399171Medicaid
095560M31Medicare ID - Type Unspecified
B93328Medicare UPIN