Provider Demographics
NPI:1487662433
Name:SIPE, PAUL G (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:G
Last Name:SIPE
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7500
Mailing Address - Fax:717-848-2074
Practice Address - Street 1:1601 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4630
Practice Address - Country:US
Practice Address - Phone:717-812-7500
Practice Address - Fax:717-848-2074
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040090E208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012572880003Medicaid
PA102885344Medicaid
PAP01448247OtherRAILROAD MEDICARE
PA665608OtherBLUE SHIELD
50049088OtherBLUE CROSS
PA0012572880003Medicaid
PA665608FLTMedicare PIN