MEDICARE: KATELYN JOSEPHINE TRIPOD 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	207V00000X	Obstetrics & Gynecology Physician	25MA10994800	NJ

General Provider Information

NPI Number	:	1770016131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN JOSEPHINE TRIPOD MD

Provider Business Mailing Address
First Line	:	123 FRANKLIN CORNER RD STE 214
Second Line	:
City	:	LAWRENCE TOWNSHIP
State	:	NJ
Zip	:	08648-2526
Country	:	US
Telephone Number	:	609-537-7200
Fax Number	:	609-537-7212

Provider Business Practice Location Address
First Line	:	123 FRANKLIN CORNER RD STE 214
Second Line	:
City	:	LAWRENCE TOWNSHIP
State	:	NJ
Zip	:	08648-2526
Country	:	US
Telephone Number	:	609-537-7200
Fax Number	:	609-537-7212

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	12/27/2023

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