Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD037200E | PA |
NPI | 1164555249 |
---|---|
Provider Name | Dr. Lee Tripp |
First Address | Philadelphia, PA 19107-6734 |
Second Address | Philadelphia, PA 19107-6734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052753000 | IBC PROVIDER # (01) | PA |