Provider Demographics
NPI:1649211129
Name:FILIPPONE, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:FILIPPONE
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 1:2228 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3923
Mailing Address - Country:US
Mailing Address - Phone:215-467-8955
Mailing Address - Fax:215-467-8956
Practice Address - Street 1:2228 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-3923
Practice Address - Country:US
Practice Address - Phone:215-467-8955
Practice Address - Fax:215-467-8956
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDO23629E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009005470001Medicaid
PAB41653Medicare UPIN