Provider Demographics
NPI:1295807477
Name:RAYMOND L. TIPTON M D PC
Entity type:Organization
Organization Name:RAYMOND L. TIPTON M D PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHAMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-827-9007
Mailing Address - Street 1:119 E MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-2161
Mailing Address - Country:US
Mailing Address - Phone:814-827-9007
Mailing Address - Fax:814-827-2548
Practice Address - Street 1:119 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-2161
Practice Address - Country:US
Practice Address - Phone:814-827-9007
Practice Address - Fax:814-827-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026931E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA605868OtherBLUE SHIELD
PA0008652410003Medicaid
PA605868OtherBLUE SHIELD