Healthcare Provider Details

I. General information

NPI: 1912980723
Provider Name (Legal Business Name): BENJAMIN L. SHIPTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 GREENVILLE RD
MERCER PA
16137-5023
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-662-2650
  • Fax: 724-662-1338
Mailing address:
  • Phone: 724-662-2650
  • Fax: 724-662-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009964L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: