Provider Demographics
NPI:1285683771
Name:THIPPESWAMY, HEBBALMATH M (MD)
Entity Type:Individual
Prefix:DR
First Name:HEBBALMATH
Middle Name:M
Last Name:THIPPESWAMY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-281-4861
Mailing Address - Fax:631-281-8546
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE # 9
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-281-4861
Practice Address - Fax:631-281-8546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
NY125473207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA97179Medicare UPIN