Provider Demographics
NPI:1104892553
Name:KIPP, H WINSTON (MD)
Entity type:Individual
Prefix:
First Name:H
Middle Name:WINSTON
Last Name:KIPP
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 1:15 ENTERPRISE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7894
Mailing Address - Country:US
Mailing Address - Phone:207-621-8700
Mailing Address - Fax:207-621-8701
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:STE 100
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7894
Practice Address - Country:US
Practice Address - Phone:207-621-8700
Practice Address - Fax:207-621-8701
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008991207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110990199Medicaid
MEB86466Medicare UPIN
ME07357101Medicare PIN
ME073571Medicare ID - Type Unspecified
ME110990199Medicaid
MEP00131225Medicare PIN