Provider Demographics
NPI:1437159951
Name:SHIPMAN, MICHAEL CHARLES (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:SHIPMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2176
Mailing Address - Country:US
Mailing Address - Phone:717-295-2323
Mailing Address - Fax:717-295-7294
Practice Address - Street 1:734 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2176
Practice Address - Country:US
Practice Address - Phone:717-295-2323
Practice Address - Fax:717-295-7294
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000192L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158841OtherMEDICARE GROUP NUMBER
PA1437159951OtherNPI
PA028667OtherMEDICARE
PA181553F8RMedicare PIN
PA028667OtherMEDICARE