Provider Demographics
NPI:1548217219
Name:LIPSHUTZ, GREG MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:MICHAEL
Last Name:LIPSHUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN STREET
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-499-2970
Mailing Address - Fax:617-499-2974
Practice Address - Street 1:300 MOUNT AUBURN STREET
Practice Address - Street 2:SUITE 409
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-499-2970
Practice Address - Fax:617-499-2974
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2009-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA702852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130022801OtherRR MEDICARE
J09492OtherBCBS MA
MA3068242Medicaid
MANX3845Medicare PIN
MA3068242Medicaid