Provider Demographics
NPI:1376596445
Name:LIPPERT, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LIPPERT
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 1:89 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-338-7125
Mailing Address - Fax:845-331-9388
Practice Address - Street 1:89 JOHN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-338-7125
Practice Address - Fax:845-331-9388
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1203821207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
141610785OtherKINGSTON TRUST FUND
287258OtherMVP ENDOCRINOLOGY
137182OtherUNITED HEALTH CARE
110227140OtherRAILROAD MEDICARE
141610785OtherCATSKILL AREA SCHOOLS
10001199OtherCOPHP
NY00505739Medicaid
117258OtherMVP INTERNAL MED
30105100OtherEMPIRE BCBS
NY141610785OtherAARP
6011874OtherGHI
000000033697OtherGHI HMO
000401428004OtherBS OF NE NY
141610785OtherNYS EMPLOYEE BENEFITS
141610785OtherCATSKILL AREA SCHOOLS
287258OtherMVP ENDOCRINOLOGY