MEDICARE: GLENN TRIPP PA

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	363A00000X	Physician Assistant	103877	NC

General Provider Information

NPI Number	:	1992782668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN TRIPP PA

Provider Business Mailing Address
First Line	:	9633 BITTER MELON DR
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-5917
Country	:	US
Telephone Number	:	919-639-8900
Fax Number	:	919-639-9500

Provider Business Practice Location Address
First Line	:	9633 BITTER MELON DR
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-5917
Country	:	US
Telephone Number	:	919-639-8900
Fax Number	:	919-639-9500

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	12/01/2010

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Directions to “ GLENN TRIPP PA” Practice Location

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