Provider Demographics
NPI:1982679007
Name:VAN RIPER, LOUISE E (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:VAN RIPER
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 1:1249 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1876
Mailing Address - Country:US
Mailing Address - Phone:304-599-6353
Mailing Address - Fax:304-598-3608
Practice Address - Street 1:1249 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1876
Practice Address - Country:US
Practice Address - Phone:304-599-6353
Practice Address - Fax:304-598-3608
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001067Medicaid
WVWV08952OtherHEALTH PLAN
WV000097303OtherBC/BS
WV000482949OtherBC/BS- PAY TO #
WV0093346000Medicaid
WV229255OtherUNITED HEALTHCARE/MAMSI
WV1513435-002OtherCIGNA
WVV001625OtherTRICARE
WVWV08952OtherHEALTH PLAN
WVA71850Medicare UPIN
WVWO9288601Medicare ID - Type UnspecifiedGROUP #