Provider Demographics
NPI:1033147947
Name:DIPPERT, PAUL C (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:DIPPERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:C
Other - Last Name:DIPPERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4979 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2547
Mailing Address - Country:US
Mailing Address - Phone:716-923-4380
Mailing Address - Fax:716-923-4384
Practice Address - Street 1:4979 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2547
Practice Address - Country:US
Practice Address - Phone:716-923-4380
Practice Address - Fax:716-923-4384
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607290Medicaid
NY00607290Medicaid