Provider Demographics
NPI:1699710525
Name:HIPOLITO, EMMANUEL F (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:F
Last Name:HIPOLITO
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 1:38 THOMPSON PARK
Mailing Address - Street 2:P O BOX 399
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-0399
Mailing Address - Country:US
Mailing Address - Phone:814-837-9841
Mailing Address - Fax:814-837-6494
Practice Address - Street 1:38 THOMPSON PARK
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-0399
Practice Address - Country:US
Practice Address - Phone:814-837-9841
Practice Address - Fax:814-837-6494
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037007L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1630113OtherBLUE SHIELD
PAC33823Medicare UPIN
PA422720TA0Medicare PIN