Provider Demographics
NPI:1366599243
Name:GRIPPO, DANIEL AARON (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:AARON
Last Name:GRIPPO
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 3239
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3239
Mailing Address - Country:US
Mailing Address - Phone:844-295-4871
Mailing Address - Fax:
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-388-1286
Practice Address - Fax:931-388-7119
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39219174400000X
TNMD2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000623463OtherANTHEM BC
TN4191316OtherBCBS TN
P00725889OtherRAILROAD MEDICARE
TN1505378Medicaid
$$$$$$$$$OtherTRICARE
TN103I302024Medicare PIN
TN4191316OtherBCBS TN
P00725889OtherRAILROAD MEDICARE