Provider Demographics
NPI:1104829142
Name:TRIPP, HENRY FRANKLIN JR (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:FRANKLIN
Last Name:TRIPP
Suffix:JR
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 1:3734 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2240
Mailing Address - Country:US
Mailing Address - Phone:336-664-0333
Mailing Address - Fax:336-992-3930
Practice Address - Street 1:3734 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2240
Practice Address - Country:US
Practice Address - Phone:336-664-0333
Practice Address - Fax:336-664-0447
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32185207QG0300X, 207R00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891231RMedicaid
NC1231ROtherBCBS
NC891231RMedicaid
NC2279630CMedicare PIN
NCNC9909AMedicare PIN