MEDICARE: MR. JOHN E PIPAS 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	092489	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	953201	OTHER	NY	MVP

General Provider Information

NPI Number	:	1477540912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN E PIPAS MD

Provider Business Mailing Address
First Line	:	2514 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1519
Country	:	US
Telephone Number	:	315-445-9022
Fax Number	:	315-449-1636

Provider Business Practice Location Address
First Line	:	2514 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1519
Country	:	US
Telephone Number	:	315-445-9022
Fax Number	:	315-449-1636

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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