Healthcare Provider Details

I. General information

NPI: 1386685477
Provider Name (Legal Business Name): RICHARD PIPPENGER JR. C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 HUNTERSWORTH
GLENWOOD MD
21738-9643
US

IV. Provider business mailing address

3231 HUNTERSWORTH
GLENWOOD MD
21738-9643
US

V. Phone/Fax

Practice location:
  • Phone: 443-350-0111
  • Fax:
Mailing address:
  • Phone: 443-350-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR132000
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: