Healthcare Provider Details

I. General information

NPI: 1871563114
Provider Name (Legal Business Name): JUDITH RIPPERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST SUITE 340
DOVER DE
19904-3485
US

IV. Provider business mailing address

PO BOX 512241
PHILADELPHIA PA
19175-2241
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-1414
  • Fax: 302-734-2121
Mailing address:
  • Phone: 302-734-1414
  • Fax: 302-734-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC2-0005033
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: