Provider Demographics
NPI:1790807139
Name:SHIPMAN PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SHIPMAN PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-497-2996
Mailing Address - Street 1:541 MASON BAY RD
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-3501
Mailing Address - Country:US
Mailing Address - Phone:207-497-2996
Mailing Address - Fax:207-497-3467
Practice Address - Street 1:1 BRICKYARD LN
Practice Address - Street 2:UNIT D
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1604
Practice Address - Country:US
Practice Address - Phone:207-497-2996
Practice Address - Fax:207-497-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5924615OtherAETNA
ME047343OtherBCBS
ME408230000Medicaid
MEG34607OtherHARVARD PILGRIM
MEM121911COtherCIGNA
ME2824368OtherAETNA
MEM221430OtherCIGNA
NH30233307Medicaid
ME7496508OtherCIGNA