=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740213024
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR M NIPPERT DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 KENNETT PIKE SUITE A-102
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-652-5767
-----------------------------------------------------
Fax | 302-652-4373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 685 UNIONVILLE RD
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-444-6520
-----------------------------------------------------
Fax | 610-444-9571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E10000085
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | SC004005L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------