Provider Demographics
NPI:1639137326
Name:SHIPLE, BRIAN J (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:SHIPLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2430
Mailing Address - Country:US
Mailing Address - Phone:302-354-4895
Mailing Address - Fax:
Practice Address - Street 1:1788 WILMINGTON PIKE
Practice Address - Street 2:SUITE 2000
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-459-4200
Practice Address - Fax:610-459-4203
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS077302-E207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80440Medicare UPIN
PA163913Medicare UPIN
DE000364N51Medicare ID - Type Unspecified