Provider Demographics
NPI:1962462028
Name:LIPSTOCK, ELLIOT A (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:A
Last Name:LIPSTOCK
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 1:276 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4430
Mailing Address - Country:US
Mailing Address - Phone:508-997-6763
Mailing Address - Fax:508-999-5735
Practice Address - Street 1:276 ALDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4430
Practice Address - Country:US
Practice Address - Phone:508-997-6763
Practice Address - Fax:508-999-5735
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2045311Medicaid
A59639Medicare UPIN
MA2045311Medicaid