Healthcare Provider Details

I. General information

NPI: 1275066862
Provider Name (Legal Business Name): RICHARD C CIPOLLONE JR. R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SUSIE CT
MIDDLETOWN DE
19709-9368
US

IV. Provider business mailing address

7 SUSIE CT
MIDDLETOWN DE
19709-9368
US

V. Phone/Fax

Practice location:
  • Phone: 610-757-8611
  • Fax:
Mailing address:
  • Phone: 610-757-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0049806
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: