Healthcare Provider Details

I. General information

NPI: 1568880144
Provider Name (Legal Business Name): VIPIN PHILIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

1012 WINTERTON ST
PITTSBURGH PA
15206-1730
US

V. Phone/Fax

Practice location:
  • Phone: 407-864-1768
  • Fax:
Mailing address:
  • Phone: 407-864-1768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101262825
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101262825
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101262825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: