Healthcare Provider Details

I. General information

NPI: 1568815710
Provider Name (Legal Business Name): DEVENDRA KUMAR TRIPATHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE
PHILADELPHIA PA
19152-2007
US

IV. Provider business mailing address

1901 FIRST AVENUE METROPOLITAN HOSPITAL CENTER DEPARTMENT OF INTERNAL MEDICINE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-6562
  • Fax: 215-350-7410
Mailing address:
  • Phone: 212-423-8099
  • Fax: 212-423-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD467824
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD467824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: