Provider Demographics
NPI:1730153024
Name:TIPPERMAN, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TIPPERMAN
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 1:100 PRESIDENTIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1108
Mailing Address - Country:US
Mailing Address - Phone:484-434-2700
Mailing Address - Fax:484-434-3793
Practice Address - Street 1:100 PRESIDENTIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:484-434-2700
Practice Address - Fax:484-434-3793
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035042E207W00000X
NJ25MA05475800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001245572-0002Medicaid
PA001245572-0011Medicaid
PAB41006Medicare UPIN
PA192842FVUMedicare PIN
PA001245572-0011Medicaid