MEDICARE: DR. PATSY P CIPOLETTI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11987	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053364778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATSY P CIPOLETTI MD

Provider Business Mailing Address
First Line	:	1421 COMMERCE STREET
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-1320
Country	:	US
Telephone Number	:	304-737-3425
Fax Number	:	304-737-2610

Provider Business Practice Location Address
First Line	:	1421 COMMERCE STREET
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-1320
Country	:	US
Telephone Number	:	304-737-3425
Fax Number	:	304-737-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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