Provider Demographics
NPI:1689859886
Name:TRIPP, SUSANNAH REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:REBECCA
Last Name:TRIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3222
Mailing Address - Country:US
Mailing Address - Phone:412-622-7343
Mailing Address - Fax:
Practice Address - Street 1:3937 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-3222
Practice Address - Country:US
Practice Address - Phone:412-622-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191035390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program