Provider Demographics
NPI:1659445849
Name:SHIPPEN, EUGENE RODMAN III (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:RODMAN
Last Name:SHIPPEN
Suffix:III
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 1:9 EAST LANCASTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607
Mailing Address - Country:US
Mailing Address - Phone:610-777-7896
Mailing Address - Fax:610-775-3677
Practice Address - Street 1:9 EAST LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:610-777-7896
Practice Address - Fax:610-775-3677
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014559E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
120111Medicare ID - Type Unspecified
C30704Medicare UPIN