Healthcare Provider Details

I. General information

NPI: 1184674558
Provider Name (Legal Business Name): MARY BERNADETTE RIPPON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W FARIS RD SUITE 320
GREENVILLE SC
29605-4253
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-1200
  • Fax: 864-455-1209
Mailing address:
  • Phone: 864-797-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number18491
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: