Provider Demographics
NPI:1730296732
Name:VILLAGE AT NEWTOWN MEDICAL CENTER PC
Entity Type:Organization
Organization Name:VILLAGE AT NEWTOWN MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-579-1300
Mailing Address - Street 1:11 FRIENDS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1803
Mailing Address - Country:US
Mailing Address - Phone:215-579-1300
Mailing Address - Fax:215-579-0150
Practice Address - Street 1:11 FRIENDS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1803
Practice Address - Country:US
Practice Address - Phone:215-579-1300
Practice Address - Fax:215-579-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563791Medicare ID - Type Unspecified