Healthcare Provider Details

I. General information

NPI: 1134118722
Provider Name (Legal Business Name): RAY WILLIAM TRIPP III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST ACTON MEDICAL ASSOCIATES PC
ACTON MA
01720-3718
US

IV. Provider business mailing address

321 MAIN STREET ACTON MEDICAL ASSOCIATES PC
ACTON MA
01720-3799
US

V. Phone/Fax

Practice location:
  • Phone: 978-263-0680
  • Fax: 978-263-4880
Mailing address:
  • Phone: 978-263-0680
  • Fax: 978-263-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38244
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2034735
Identifier TypeMEDICAID
Identifier StateMS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: