Provider Demographics
NPI:1013960764
Name:SHIPKIN, PAUL M (MD, PC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:SHIPKIN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREENWOOD AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2627
Mailing Address - Country:US
Mailing Address - Phone:215-293-9140
Mailing Address - Fax:215-293-9143
Practice Address - Street 1:101 GREENWOOD AVE STE 450
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2627
Practice Address - Country:US
Practice Address - Phone:215-293-9140
Practice Address - Fax:215-293-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 014493E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157657Medicare ID - Type Unspecified
PAB40208Medicare UPIN