Provider Demographics
NPI:1669465324
Name:LIPORACE, RALPH L (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:L
Last Name:LIPORACE
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 1:66 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1750
Mailing Address - Country:US
Mailing Address - Phone:518-262-4439
Mailing Address - Fax:518-262-2169
Practice Address - Street 1:66 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1750
Practice Address - Country:US
Practice Address - Phone:518-262-4439
Practice Address - Fax:518-262-2169
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190001207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477994Medicaid
NYF81740Medicare ID - Type Unspecified
NY01477994Medicaid