Provider Demographics
NPI:1376514133
Name:KEIPPER, VINCENT L (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:KEIPPER
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 1:319 PENNY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1221
Mailing Address - Country:US
Mailing Address - Phone:704-403-7780
Mailing Address - Fax:704-403-7781
Practice Address - Street 1:319 PENNY LN
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-403-7780
Practice Address - Fax:704-403-7781
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4324689OtherAETNA ID
NC8118655OtherMAMSI ID
NC110223581OtherRAILROAD MEDICARE
NC111009OtherWELLPATH
NC0440082OtherUNITED HEALTHCARE
NC8948035Medicaid
NC48035OtherBCBS ID
NC6042OtherPARTNERS MEDICARE CHOICE
NC232009OtherMEDICARE OTHER
NC26274OtherMEDCOST ID
NC566000156OtherPRACTICE TAX ID
NCC84862Medicare UPIN
NC2064802Medicare PIN
NC8948035Medicaid