Provider Demographics
NPI:1407810674
Name:LIPOLD, LAURA D (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:LIPOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26900 CEDAR RD
Mailing Address - Street 2:SUITE 22N
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1191
Mailing Address - Country:US
Mailing Address - Phone:216-839-3900
Mailing Address - Fax:216-839-3931
Practice Address - Street 1:26900 CEDAR RD
Practice Address - Street 2:SUITE 22N
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1191
Practice Address - Country:US
Practice Address - Phone:216-839-3900
Practice Address - Fax:216-839-3931
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35075243D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290211Medicaid
OHH44287Medicare UPIN