Provider Demographics
NPI:1528242831
Name:TIPPETT, DEAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:SCOTT
Last Name:TIPPETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 WILKENS AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4843
Mailing Address - Country:US
Mailing Address - Phone:410-247-6500
Mailing Address - Fax:410-247-3337
Practice Address - Street 1:4600 WILKENS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4843
Practice Address - Country:US
Practice Address - Phone:410-247-6500
Practice Address - Fax:410-247-3337
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD367482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF01416Medicare UPIN