Provider Demographics
NPI:1821081415
Name:SKIPPER, CAROL CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CHRISTINE
Last Name:SKIPPER
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 1:115 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5526
Mailing Address - Country:US
Mailing Address - Phone:201-547-3555
Mailing Address - Fax:201-547-8259
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-547-3555
Practice Address - Fax:201-547-8259
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA071041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8037209Medicaid
NJ043604Medicare ID - Type Unspecified
NJH28110Medicare UPIN