Provider Demographics
NPI:1346487667
Name:SHIPLEY, RACHEL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANN
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:2090 HARRISON AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1153
Practice Address - Country:US
Practice Address - Phone:724-744-6167
Practice Address - Fax:724-744-6070
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438080207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102504742Medicaid
PA102504742Medicaid