Provider Demographics
NPI:1003873332
Name:HYPPOLITE, JENNY (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HYPPOLITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602522
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2522
Mailing Address - Country:US
Mailing Address - Phone:252-633-1010
Mailing Address - Fax:252-224-3071
Practice Address - Street 1:2604 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4238
Practice Address - Country:US
Practice Address - Phone:252-638-4023
Practice Address - Fax:252-633-2833
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229513207R00000X
NC2009-00116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159911BJOtherPREFERRED CARE #
NY229513-7WOtherWORKERS COMP #
NY000528062002OtherHEALTH NOW BCBS #
NY00026311602OtherUNIVERA #
NY040426035712OtherFIDELIS CARE #
NYP00245255OtherMEDICARE RAILROAD #
NY0145199OtherGHI PPO #
NY0197357OtherIHA #
NC5910994Medicaid
NC151T3OtherBCBSNC
NY00026311602OtherUNIVERA #
NY229513-7WOtherWORKERS COMP #
NY0197357OtherIHA #