Provider Demographics
NPI:1699382796
Name:LIPSCOMB, ROY
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 21ST ST NE APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3158
Mailing Address - Country:US
Mailing Address - Phone:202-384-9873
Mailing Address - Fax:
Practice Address - Street 1:914 49TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4822
Practice Address - Country:US
Practice Address - Phone:202-384-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC23344II00374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide