Provider Demographics
NPI:1033648662
Name:RIPON, SULTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SULTAN
Middle Name:
Last Name:RIPON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W GARDEN ST STE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2657
Mailing Address - Country:US
Mailing Address - Phone:315-567-0777
Mailing Address - Fax:315-702-8393
Practice Address - Street 1:37 W GARDEN ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2657
Practice Address - Country:US
Practice Address - Phone:315-567-0777
Practice Address - Fax:315-702-8393
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06124785Medicaid