1013193135 NPI number — DABNEY LIPSCOMB NP

Table of content: DABNEY LIPSCOMB NP (NPI 1013193135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013193135 NPI number — DABNEY LIPSCOMB NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSCOMB
Provider First Name:
DABNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1013193135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6572
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
WAYSON PAVILION, SUITE 150
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-7992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-481-1199
Provider Business Practice Location Address Fax Number:
443-481-1495
Provider Enumeration Date:
01/18/2008

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: 363LW0102X , with the licence number:  R196779 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 046613100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: X3640006 . This is a "CAREFIRST DC BOWIE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N4350007 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000974200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97601602 . This is a "CAREFIRST MD BOWIE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97601601 . This is a "CAREFIRST MD ANNAPOLIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97601603 . This is a "CAREFIRST MD PRINCE FREDERICK MD" identifier . This identifiers is of the category "OTHER".




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