Provider Demographics
NPI:1033183777
Name:COULTER, PIPPA ELAYNE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PIPPA
Middle Name:ELAYNE
Last Name:COULTER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:PIPPA
Other - Middle Name:COULTER
Other - Last Name:ABSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1275 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5770
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2200 TYDD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1284
Practice Address - Country:US
Practice Address - Phone:707-269-7051
Practice Address - Fax:707-269-7054
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524758Medicaid
AL21426OtherLICENSE