Basic Information
| Provider Information | |||||||||
| NPI: | 1811342645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUPCICH | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 T W ALEXANDER DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276174883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193500953 | ||||||||
| FaxNumber: | 9193500944 | ||||||||
| Practice Location | |||||||||
| Address1: | 8001 T W ALEXANDER DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276174883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193500953 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME140754 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2020-03161 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103383800 | 05 | FL | MEDICAID |