Provider Demographics
NPI:1154331452
Name:KIPP, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KIPP
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 1:11 FRIENDS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1803
Mailing Address - Country:US
Mailing Address - Phone:215-579-1300
Mailing Address - Fax:215-579-0150
Practice Address - Street 1:11 FRIENDS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1803
Practice Address - Country:US
Practice Address - Phone:215-579-1300
Practice Address - Fax:215-579-0150
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029520E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKI070594Medicare ID - Type Unspecified
E52743Medicare UPIN