1003872797 NPI number — DR. JOHN J CIPRIANO MD

Table of content: DR. JOHN J CIPRIANO MD (NPI 1003872797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003872797 NPI number — DR. JOHN J CIPRIANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIPRIANO
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003872797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1416 MONROE AVE
Provider Second Line Business Mailing Address:
SUITE204
Provider Business Mailing Address City Name:
DUNMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18509-2477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-963-0913
Provider Business Mailing Address Fax Number:
570-963-6153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1416 MONROE AVE
Provider Second Line Business Practice Location Address:
SUITE204
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-963-0913
Provider Business Practice Location Address Fax Number:
570-963-6153
Provider Enumeration Date:
04/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD038194E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0011265440001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 243887 . This is a "PHI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 529891 . This is a "FIRST PRIORITY LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7020 . This is a "GEISINGER GOLD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00257491 . This is a "RRMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001197 . This is a "FPH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2468251 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 529891 . This is a "PA BLUE SHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E71403 . This is a "STERLING" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 7020 . This is a "PHP GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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