Provider Demographics
NPI:1134118722
Name:TRIPP, RAY WILLIAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:WILLIAM
Last Name:TRIPP
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 MAIN STREET
Mailing Address - Street 2:ACTON MEDICAL ASSOCIATES PC
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3799
Mailing Address - Country:US
Mailing Address - Phone:978-263-0680
Mailing Address - Fax:978-263-4880
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:ACTON MEDICAL ASSOCIATES PC
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3718
Practice Address - Country:US
Practice Address - Phone:978-263-0680
Practice Address - Fax:978-263-4880
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2034735Medicaid
MSB01028Medicare ID - Type Unspecified
MSD88027Medicare UPIN