MEDICARE: MADELINE DIANNE RIPA 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	207W00000X	Ophthalmology Physician	125067960	IL
2	207W00000X	Ophthalmology Physician	11191801-1205	UT
3	207W00000X	Ophthalmology Physician	2015019310	MO
4	207WX0120X	Cornea and External Diseases Specialist Physician	036.151523	IL
5	207W00000X	Ophthalmology Physician	C200556	CA

General Provider Information

NPI Number	:	1932580644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE DIANNE RIPA M.D.

Provider Business Mailing Address
First Line	:	3035 CLEVELAND AVE STE 100
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3037
Country	:	US
Telephone Number	:	707-546-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 CLEVELAND AVE STE 100
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3037
Country	:	US
Telephone Number	:	707-546-9800
Fax Number	:	707-899-7980

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

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	07/29/2025

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