1346487667 NPI number — DR. RACHEL ANN SHIPLEY M.D.

Table of content: DR. RACHEL ANN SHIPLEY M.D. (NPI 1346487667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346487667 NPI number — DR. RACHEL ANN SHIPLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPLEY
Provider First Name:
RACHEL
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOVER
Provider Other First Name:
RACHEL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346487667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-8060
Provider Business Mailing Address Fax Number:
724-522-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2090 HARRISON AVE
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-744-6167
Provider Business Practice Location Address Fax Number:
724-744-6070
Provider Enumeration Date:
01/08/2009

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: 207RG0300X , with the licence number:  MD438080 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD438080 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 102504742 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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