MEDICARE: EMMANUEL F HIPOLITO M.D.

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	MD037007L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1630113	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1699710525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL F HIPOLITO M.D.

Provider Business Mailing Address
First Line	:	38 THOMPSON PARK
Second Line	:	P O BOX 399
City	:	KANE
State	:	PA
Zip	:	16735-0399
Country	:	US
Telephone Number	:	814-837-9841
Fax Number	:	814-837-6494

Provider Business Practice Location Address
First Line	:	38 THOMPSON PARK
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-0399
Country	:	US
Telephone Number	:	814-837-9841
Fax Number	:	814-837-6494

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	09/25/2012

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