Provider Demographics
NPI:1831262922
Name:PIPPAS, ANDREW W (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:PIPPAS
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 1:1831 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-320-8780
Mailing Address - Fax:706-660-2583
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-320-8780
Practice Address - Fax:706-660-2583
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053506207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937965Medicaid
AL60035437OtherBCBS
7814546OtherAETNA
GA246604314AMedicaid
5825786483901-B001OtherWPS-TRICARE
AL009957965OtherCAID
GA252002OtherBCBS
582578648OtherEVERGREEN
GA305012OtherWELLCARE
58257864831901B001OtherTRICARE WPS
P00109714OtherRR MEDICARE
AL009937965Medicaid
GA252002OtherBCBS
P00108794Medicare ID - Type UnspecifiedRR