Provider Demographics
NPI:1346297686
Name:FILIPPONE, EDWARD C (PA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:FILIPPONE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634909
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4909
Mailing Address - Country:US
Mailing Address - Phone:865-985-7234
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:908 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3894
Practice Address - Country:US
Practice Address - Phone:423-586-4231
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4031542OtherBCBS
TNP37144Medicare UPIN
TN4031542OtherBCBS