Provider Demographics
NPI:1013145101
Name:VANMETER, KIPP EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:KIPP
Middle Name:EDWARD
Last Name:VANMETER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARTFORD HEALTHCARE URGENT CARE
Mailing Address - Street 2:339 WEST MAIN STREET
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-696-4460
Mailing Address - Fax:
Practice Address - Street 1:117 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2507
Practice Address - Country:US
Practice Address - Phone:860-658-3444
Practice Address - Fax:860-658-3458
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine