Provider Demographics
NPI:1255336582
Name:RIPICH, GREGORY GUIDO (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:GUIDO
Last Name:RIPICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAMILTON
Other - Middle Name:MEDICAL
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-9575
Mailing Address - Country:US
Mailing Address - Phone:315-824-7040
Mailing Address - Fax:315-501-1070
Practice Address - Street 1:150 BROAD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-9575
Practice Address - Country:US
Practice Address - Phone:315-824-7040
Practice Address - Fax:315-501-1070
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210433208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01861669Medicaid
NYJ400006594Medicare PIN
NY01861669Medicaid