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1063483121

NPI Code Detail

MEDICARE: CONSTANTINE PHIRIPES MD

MEDICARE: CONSTANTINE PHIRIPES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	S7117	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ38477Z	OTHER	CA	MEDICARE GROUP ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	942497568	OTHER	CA	BLUE SHIELD
3	00G56470	OTHER	CA	BLUE CROSS
4	00G56470	OTHER	CA	UNITED HEALTHCARE
5	00G56470	OTHER	CA	AETNA
6	942497568	OTHER	CA	BLUE CROSS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	00G56470	OTHER	CA	BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063483121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTINE PHIRIPES MD

Provider Business Mailing Address
First Line	:	PO BOX 746079
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6079
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	4115 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3614
Country	:	US
Telephone Number	:	817-796-7370
Fax Number	:	817-764-0714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/21/2022

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1912137977 — MS. ANGELA K WICKSTRUM PA-C
Practice Location Address:

4115 E LANCASTER AVE
FORT WORTH, TX
76103-3614

Practice Phone: 817-369-8526
Practice Fax: 817-764-0714

1558813485 — OFEAR MOORE NORRIS NP
Practice Location Address:

4115 E LANCASTER AVE
FORT WORTH, TX
76103-3614

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Practice Fax:

1619492964 — MRS. CRISTINA MATA RODRIGUEZ PA-C
Practice Location Address:

4115 E LANCASTER AVE
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76103-3614

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Practice Fax:

1811408644 — MRS. GIBSON ANN HERNANDEZ RN, AGPCNP-BC
Practice Location Address:

4115 E LANCASTER AVE
FORT WORTH, TX
76103-3614

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Practice Fax: 817-764-0714

1245737493 — ANH TUYET VU DO
Practice Location Address:

4115 E LANCASTER AVE
FORT WORTH, TX
76103-3614

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Practice Fax:

1831678226 — ANEEQA SHAMSHAD BUTT
Practice Location Address:

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Directions to “ CONSTANTINE PHIRIPES MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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