Provider Demographics
NPI:1750363685
Name:TIPTON, CHRISTOPHER JOSEPH (PAC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:TIPTON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5885
Practice Address - Street 1:600 E MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1023
Practice Address - Country:US
Practice Address - Phone:304-583-8585
Practice Address - Fax:304-583-0129
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV969363AM0700X
WV342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025955Medicaid
WVWV2742CMedicare Oscar/Certification
WVWV2742EMedicare Oscar/Certification
WVWV2742FMedicare Oscar/Certification
WVWV2742B663Medicare Oscar/Certification
WVP68880Medicare UPIN
WVWV2742B662Medicare Oscar/Certification
WVWV2742BMedicare Oscar/Certification
WVWV2742HMedicare Oscar/Certification
WVWV2742DMedicare Oscar/Certification
WV3810025955Medicaid
WVWV2742GMedicare Oscar/Certification
WVWV2742AMedicare Oscar/Certification