Provider Demographics
NPI:1245214188
Name:LIPSON, NANCY P (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:P
Last Name:LIPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:R
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2102 N. COUNTRY CLUB, BLDG. B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-795-8371
Mailing Address - Fax:520-320-3808
Practice Address - Street 1:2102 N. COUNTRY CLUB, BLDG. B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-795-8371
Practice Address - Fax:520-320-3808
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037236A208100000X
AZ48401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100128760Medicaid
IN100128760Medicaid
IN061570VMedicare PIN
IN4723080004Medicare NSC