Provider Demographics
NPI:1700887932
Name:TRIPPE, GLENN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOHN
Last Name:TRIPPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:282 BENEDICT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2712
Mailing Address - Country:US
Mailing Address - Phone:419-668-9409
Mailing Address - Fax:419-668-7099
Practice Address - Street 1:282 BENEDICT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2712
Practice Address - Country:US
Practice Address - Phone:419-668-9409
Practice Address - Fax:419-668-7099
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35043009T208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0462717Medicaid
OHC03029Medicare UPIN