1285661496 NPI number — DR. LEON W LIPSON M.D.

Table of content: DR. LEON W LIPSON M.D. (NPI 1285661496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285661496 NPI number — DR. LEON W LIPSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSON
Provider First Name:
LEON
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285661496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 EL CAMINO REAL
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94306-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-329-9100
Provider Business Mailing Address Fax Number:
650-631-2448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94306-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-631-8300
Provider Business Practice Location Address Fax Number:
650-631-2448
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  G12424 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040003493 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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