Provider Demographics
NPI:1770677759
Name:LIPPMAN, KENNETH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:LIPPMAN
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 1:809 N CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5335
Mailing Address - Country:US
Mailing Address - Phone:410-752-1532
Mailing Address - Fax:410-752-7025
Practice Address - Street 1:809 N CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5335
Practice Address - Country:US
Practice Address - Phone:410-752-1532
Practice Address - Fax:410-752-7025
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027275207X00000X
FLME43996207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK4230001OtherCAREFIRST BLUE CHOICE
MD35082501OtherBLUE CROSS BLUE SHIELD
146250400OtherUS DEPT OF LABOR
MD466841300Medicaid
C57448Medicare UPIN
MD5898Medicare ID - Type Unspecified