1447259478 NPI number — CHERYL SANDRA LIPSON M.D.

Table of content: CHERYL SANDRA LIPSON M.D. (NPI 1447259478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259478 NPI number — CHERYL SANDRA LIPSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSON
Provider First Name:
CHERYL
Provider Middle Name:
SANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1447259478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 DELAWARE AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PALMERTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18071-1858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-826-6353
Provider Business Mailing Address Fax Number:
610-826-6359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 DELAWARE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PALMERTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18071-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-826-6353
Provider Business Practice Location Address Fax Number:
610-826-6359
Provider Enumeration Date:
07/20/2005

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: 207R00000X , with the licence number:  MD037243E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MD037243E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LI101650 . This is a "BLUE SHIELD IDIV.NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002660 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02292600 . This is a "CAPITAL BLUE CROSS GRP. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001258810 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001642680 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390004526 . This is a "RAILROAD MEDICARE ID. NUM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CA869935 . This is a "BLUE SHIELD GRP. NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P1607796 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01046401 . This is a "CAPITAL BLUE CROSS ID." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020286200 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CE2338 . This is a "RAILROAD MEDICARE GRP.NUM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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