Provider Demographics
NPI:1962463216
Name:LIPPMAN, STEPHEN SAMUEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SAMUEL
Last Name:LIPPMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13538 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1243
Mailing Address - Country:US
Mailing Address - Phone:301-992-6301
Mailing Address - Fax:301-824-7631
Practice Address - Street 1:13538 EDGEMONT RD
Practice Address - Street 2:
Practice Address - City:SMITHSBURG
Practice Address - State:MD
Practice Address - Zip Code:21783-1243
Practice Address - Country:US
Practice Address - Phone:301-992-6301
Practice Address - Fax:301-824-7631
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035547207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP6224OtherINFORMED
MD419900600Medicaid
MD528959-05OtherCAREFIRST/BLUECROSS PROVI
MD110240871OtherRAILROAD MEDICARE
MD0L50SSOtherCAREFIRST/BLUECROSS GROUP
MDP6224OtherINFORMED
MD419900600Medicaid