Provider Demographics
NPI:1043200199
Name:LIPKOWITZ, GEORGE S (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:LIPKOWITZ
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 366
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0366
Mailing Address - Country:US
Mailing Address - Phone:413-733-0010
Mailing Address - Fax:413-930-2108
Practice Address - Street 1:208 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1353
Practice Address - Country:US
Practice Address - Phone:413-747-1817
Practice Address - Fax:413-747-6120
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034227208600000X
MA60301208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3038335Medicaid
CT003087873Medicaid
NH30203995Medicaid
VT1003623Medicaid
CT003087873Medicaid
VT1003623Medicaid
CT020001324Medicare PIN
MAJ07689Medicare PIN