Provider Demographics
NPI:1922082536
Name:SHIPON, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:SHIPON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2422 S BROAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4418
Mailing Address - Country:US
Mailing Address - Phone:215-389-1748
Mailing Address - Fax:215-389-0604
Practice Address - Street 1:2422 S BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4418
Practice Address - Country:US
Practice Address - Phone:215-389-1748
Practice Address - Fax:215-389-0604
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065851L207RC0000X
NJ25MA08182200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019517560001Medicaid
PA068009Medicare PIN
PAH80653Medicare UPIN