Provider Demographics
NPI:1538115480
Name:LIPMAN, MATTHEW JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:LIPMAN
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 1:4452 EASTGATE BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1584
Mailing Address - Country:US
Mailing Address - Phone:513-752-5700
Mailing Address - Fax:513-752-5716
Practice Address - Street 1:4452 EASTGATE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1584
Practice Address - Country:US
Practice Address - Phone:513-752-5700
Practice Address - Fax:513-752-5716
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047795207W00000X
KY24489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH65921157Medicaid
KY64782527Medicaid
OH36000917Medicaid
OH65928707Medicaid
OH0513359Medicaid
KY65945511Medicaid
KY0388411Medicare PIN
OHC02370Medicare UPIN
OH0515577Medicare PIN
OH0513359Medicaid
OH0515576Medicare PIN
OH36000917Medicaid
KY180040948Medicare PIN