MEDICARE: DR. MARY GELETTA RIPPLE 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	207ZF0201X	Forensic Pathology Physician	D0055316	MD

General Provider Information

NPI Number	:	1932243599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY GELETTA RIPPLE M.D.

Provider Business Mailing Address
First Line	:	1200 BEACH PROMENADE
Second Line	:
City	:	ORCHARD BEACH
State	:	MD
Zip	:	21226-2102
Country	:	US
Telephone Number	:	443-375-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W BALTIMORE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21223-2595
Country	:	US
Telephone Number	:	410-333-3265
Fax Number	:	410-333-3063

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	12/13/2012

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