Healthcare Provider Details

I. General information

NPI: 1972660975
Provider Name (Legal Business Name): NEERAJ TRIPATHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/21/2022
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PROVIDENCE RD
SECANE PA
19018-2920
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 106
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 610-394-1234
  • Fax: 610-284-4811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0548113L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: