Provider Demographics
NPI:1700128584
Name:SHIPP, DESMOND M (MD)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:M
Last Name:SHIPP
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-1707
Mailing Address - Fax:614-293-1716
Practice Address - Street 1:540 OFFICENTER PL
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5317
Practice Address - Country:US
Practice Address - Phone:614-293-1707
Practice Address - Fax:614-293-1716
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298614207NS0135X
OH35.130388207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology