Provider Demographics
NPI:1871563114
Name:RIPPERT, JUDITH (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:RIPPERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO
Mailing Address - Street 2:BOX 512241
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19175-2241
Mailing Address - Country:US
Mailing Address - Phone:302-734-1414
Mailing Address - Fax:302-734-2121
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 340
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-734-1414
Practice Address - Fax:302-734-2121
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005033207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000885803Medicaid
DEG02339D01Medicare PIN
DEG49214Medicare UPIN