Provider Demographics
NPI:1336177195
Name:TRIPP, SAMUEL E (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 LONG POND RD
Mailing Address - Street 2:STE #404
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-225-7550
Mailing Address - Fax:585-225-7719
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:STE #404
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-225-7550
Practice Address - Fax:585-225-7719
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214688207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01982269Medicaid
NYRA0140-GRP:BA0017Medicare PIN
NY01982269Medicaid
NYRA0140-GRP:BA0017Medicare PIN