Healthcare Provider Details

I. General information

NPI: 1598291601
Provider Name (Legal Business Name): JENNIFER CIPULLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-6340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: