Provider Demographics
NPI:1285037861
Name:SHIPP, MADISON MORIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MORIN
Last Name:SHIPP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:MARIE
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:125 DOUGHTY ST STE 660
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5731
Practice Address - Country:US
Practice Address - Phone:843-577-7550
Practice Address - Fax:843-853-5588
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2203363AS0400X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2047PAMedicaid
SCD043OtherARCIS HEALTHCARE MEDICARE GROUP PTAN
SCDU4331OtherARCIS HEALTHCARE RAILROAD MEDICARE GROUP PTAN
SCGP6337OtherARCIS HEALTHCARE MEDICAID GROUP NO.
SCDU4331OtherARCIS HEALTHCARE RAILROAD MEDICARE GROUP PTAN