MEDICARE: DR. DENNIS R. NORTHRIP M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	23287	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000652188	OTHER	KY	ANTHEM BC/BS

General Provider Information

NPI Number	:	1811137441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS R. NORTHRIP M.D.

Provider Business Mailing Address
First Line	:	280 PASADENA DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2925
Country	:	US
Telephone Number	:	859-278-1316
Fax Number	:	859-276-1574

Provider Business Practice Location Address
First Line	:	2416 REGENCY ROAD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2951
Country	:	US
Telephone Number	:	859-278-1316
Fax Number	:	859-276-1574

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

Provider Enumeration Date	:	02/22/2009
Last Update Date	:	02/19/2013

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