Provider Demographics
NPI:1982646378
Name:GRIPPO, VINCENZO (MD)
Entity Type:Individual
Prefix:
First Name:VINCENZO
Middle Name:
Last Name:GRIPPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3862
Mailing Address - Country:US
Mailing Address - Phone:410-342-0333
Mailing Address - Fax:410-732-7427
Practice Address - Street 1:2801 FOSTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3816
Practice Address - Country:US
Practice Address - Phone:410-342-0333
Practice Address - Fax:410-732-7427
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD289520000Medicaid
DC0007OtherBCBS BLUECHOICE
MD289520000Medicaid
MD531024-08OtherBCBS (MD)
MD289520000Medicaid