Provider Demographics
NPI:1477586014
Name:CIPORKIN, GEORGE PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PHILIP
Last Name:CIPORKIN
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 1:475 2ND ST N
Mailing Address - Street 2:UNIT # 701
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3029
Mailing Address - Country:US
Mailing Address - Phone:727-365-0906
Mailing Address - Fax:
Practice Address - Street 1:475 2ND ST N
Practice Address - Street 2:UNIT # 701
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3029
Practice Address - Country:US
Practice Address - Phone:727-365-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME777132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G38295Medicare UPIN