Healthcare Provider Details

I. General information

NPI: 1629059753
Provider Name (Legal Business Name): DAVID SHIPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST BIMC DEPT OF PEDIATRICS
NEW YORK NY
10003
US

IV. Provider business mailing address

PO BOX 95000-2436
PHILADELPHIA PA
19195-2436
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2496
  • Fax:
Mailing address:
  • Phone: 212-844-8326
  • Fax: 212-844-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: