Provider Demographics
NPI:1821257502
Name:LIPP, MAURA J (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:J
Last Name:LIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303B
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-490-7775
Mailing Address - Fax:931-490-7797
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-490-7775
Practice Address - Fax:931-490-7797
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43539207RH0002X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725122Medicaid
TN1505781Medicaid
4190929OtherBCBST
TN3725122Medicaid
4190929OtherBCBST
3001841Medicare PIN