Provider Demographics
NPI:1417952490
Name:PIPES, SAMUEL JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:PIPES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1190
Mailing Address - Country:US
Mailing Address - Phone:330-847-7217
Mailing Address - Fax:330-847-0563
Practice Address - Street 1:5975 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1190
Practice Address - Country:US
Practice Address - Phone:330-847-7217
Practice Address - Fax:330-847-0563
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2108-P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130557OtherANTHEM
OH791011752OtherRAILROAD MEDICARE
OH4610331OtherAETNA
OH0101892OtherUNITED HEALTHCARE
OH0256977Medicaid
OH341336235026OtherCARE SOURCE
OH59277OtherQUALCHOICE
OH341336235OtherFEDERAL ID
OH0256977Medicaid
OH4610331OtherAETNA
OHPI0404953Medicare PIN