Provider Demographics
NPI:1053311639
Name:FELIPA, VICTOR RAUL (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:RAUL
Last Name:FELIPA
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:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:HYNDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15545-0706
Mailing Address - Country:US
Mailing Address - Phone:814-842-3206
Mailing Address - Fax:814-842-9169
Practice Address - Street 1:144 5TH AVE
Practice Address - Street 2:
Practice Address - City:HYNDMAN
Practice Address - State:PA
Practice Address - Zip Code:15545-7379
Practice Address - Country:US
Practice Address - Phone:814-842-3206
Practice Address - Fax:814-842-9169
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-07-19
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
MDD130601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH852992OtherMAMSI
MD110023637OtherRAILROAD MEDICARE
MD3147 OR 41343601OtherBLUE SHIELD
MD781611100Medicaid
MD3147 OR 41343601OtherBLUE SHIELD
MDC49197Medicare UPIN