Provider Demographics
NPI:1669794962
Name:TIPPETT, PETER STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:STEVEN
Last Name:TIPPETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9893 GEORGETOWN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2617
Mailing Address - Country:US
Mailing Address - Phone:202-294-4443
Mailing Address - Fax:703-652-4570
Practice Address - Street 1:9893 GEORGETOWN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2617
Practice Address - Country:US
Practice Address - Phone:202-294-4443
Practice Address - Fax:703-652-4570
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43189207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine