Provider Demographics
NPI:1740213024
Name:NIPPERT, VICTOR M (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:NIPPERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-6520
Mailing Address - Fax:610-444-9571
Practice Address - Street 1:3801 KENNETT PIKE
Practice Address - Street 2:SUITE A-102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807
Practice Address - Country:US
Practice Address - Phone:302-652-5767
Practice Address - Fax:302-652-4373
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000085213E00000X
PASC004005L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0335570001OtherDMEPOS
DE0000061217Medicaid
PA100731311Medicaid
DE0335570001OtherDMEPOS
DE002870F28Medicare PIN
DE0335570001OtherDMEPOS
PA064009D0KMedicare PIN