Provider Demographics
NPI:1639798903
Name:LIPSCOMB, TRAVIS CHASE (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:CHASE
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 JEFFERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3102
Mailing Address - Country:US
Mailing Address - Phone:757-594-3800
Mailing Address - Fax:757-594-3818
Practice Address - Street 1:10510 JEFFERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:757-594-3800
Practice Address - Fax:757-594-3818
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-29
Deactivation Date:2020-04-17
Deactivation Code:
Reactivation Date:2020-04-29
Provider Licenses
StateLicense IDTaxonomies
VAT67043880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine