Provider Demographics
NPI:1730122045
Name:ZIPIN, EARL F (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:F
Last Name:ZIPIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LESLIE LANE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2152
Mailing Address - Country:US
Mailing Address - Phone:215-628-3268
Mailing Address - Fax:
Practice Address - Street 1:25 WASHINGTON LANE
Practice Address - Street 2:WYNCOTE STE C22 & STE AZ
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-885-2772
Practice Address - Fax:215-885-5215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002621L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
041853Medicare ID - Type Unspecified
B34229Medicare UPIN