Provider Demographics
NPI:1467403121
Name:TRIPP, PATRICK M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:TRIPP
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 1:3400 CIVIC CENTER
Mailing Address - Street 2:PCAM - RADIATION ONCOLOGY TRC 2 WEST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2428
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER
Practice Address - Street 2:PCAM - RADIATION ONCOLOGY TRC 2 WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI480252085R0001X
PAMD4466532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34638200Medicaid
039906262HOtherHUMANA
WI34638200Medicaid
039906262HOtherHUMANA