Provider Demographics
NPI:1881153955
Name:KUPRIS, AMANDA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SUE
Last Name:KUPRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:601 OBERLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1126
Practice Address - Country:US
Practice Address - Phone:919-235-6566
Practice Address - Fax:919-235-6532
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61309883207Q00000X
MN70242207Q00000X
NC2024-02722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1881153955Medicaid