Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 18491 | SC |
NPI | 1184674558 |
---|---|
Provider Name | Mary Bernadette Rippon |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29605-4253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 31/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020053706 | RR MEDICARE (01) | SC |
E48397 | (02) | SC |
T25991 | (05) | SC |