Provider Demographics
NPI:1093914129
Name:DAVID U LIPSITZ, MD
Entity Type:Organization
Organization Name:DAVID U LIPSITZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:URI
Authorized Official - Last Name:LIPSITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-896-9830
Mailing Address - Street 1:349 COPPERFIELD BLVD NE STE L
Mailing Address - Street 2:SUITE 369
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2432
Mailing Address - Country:US
Mailing Address - Phone:704-896-9830
Mailing Address - Fax:704-896-7815
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-783-3311
Practice Address - Fax:704-783-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127YNMedicaid
NC89127YNMedicaid