Provider Demographics
NPI:1750338315
Name:RIPKIN, DOUGLAS J (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:RIPKIN
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 1:9424 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5226
Mailing Address - Country:US
Mailing Address - Phone:330-422-1111
Mailing Address - Fax:330-422-1110
Practice Address - Street 1:9424 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5226
Practice Address - Country:US
Practice Address - Phone:330-422-1111
Practice Address - Fax:330-422-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0696582Medicaid
OHP00966613OtherRAILROAD MEDICARE
OH0611209Medicare PIN
OHA82919Medicare UPIN
OH0696582Medicaid