Provider Demographics
NPI:1679783856
Name:PIPTA, MICHELLE (PA, RDH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PIPTA
Suffix:
Gender:F
Credentials:PA, RDH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:NEUHALFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6569
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3773
Practice Address - Country:US
Practice Address - Phone:443-481-1750
Practice Address - Fax:443-481-1687
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203987124Q00000X
MDC05939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
466589Y5ZMedicare PIN