Provider Demographics
NPI:1467457218
Name:LIPSON, ANITA (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LIPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:CHEVRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:WOODY CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81656-0597
Mailing Address - Country:US
Mailing Address - Phone:215-760-5544
Mailing Address - Fax:
Practice Address - Street 1:827 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:GLADWYNE
Practice Address - State:PA
Practice Address - Zip Code:19035-1402
Practice Address - Country:US
Practice Address - Phone:215-760-5544
Practice Address - Fax:888-511-3045
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041229E207U00000X, 207UN0901X
CODR.0063043207U00000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF44077Medicare UPIN