Provider Demographics
NPI:1093953580
Name:SHIPSKY, LORI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:SHIPSKY
Suffix:
Gender:F
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 399
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0399
Mailing Address - Country:US
Mailing Address - Phone:570-586-8879
Mailing Address - Fax:570-586-3953
Practice Address - Street 1:110 LAYTON ROAD
Practice Address - Street 2:
Practice Address - City:CHINCHILLA
Practice Address - State:PA
Practice Address - Zip Code:18410-0399
Practice Address - Country:US
Practice Address - Phone:570-586-8879
Practice Address - Fax:570-586-3953
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026623490001Medicaid
PA235467YZB7Medicare PIN