Provider Demographics
NPI:1437113164
Name:LIPFORD, BENITA (MD)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:LIPFORD
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 1:1001 HUMBOLDT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-2221
Mailing Address - Country:US
Mailing Address - Phone:716-887-8282
Mailing Address - Fax:
Practice Address - Street 1:1001 HUMBOLDT PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-2221
Practice Address - Country:US
Practice Address - Phone:716-887-8282
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53685Medicare UPIN
DD0227Medicare ID - Type Unspecified