Healthcare Provider Details

I. General information

NPI: 1174599005
Provider Name (Legal Business Name): PAUL D TIPPET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 BROOKTREE COURT SUITE 100
WEXFORD PA
15090-9282
US

IV. Provider business mailing address

6400 BROOKTREE COURT SUITE 100
WEXFORD PA
15090-9282
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-3310
  • Fax: 724-933-3320
Mailing address:
  • Phone: 724-933-3310
  • Fax: 724-933-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD041136E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: