Provider Demographics
NPI:1962470633
Name:LIPPHARDT, TODD DAVID (PA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:LIPPHARDT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-0254
Mailing Address - Country:US
Mailing Address - Phone:828-708-9876
Mailing Address - Fax:828-708-9876
Practice Address - Street 1:209 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7622
Practice Address - Country:US
Practice Address - Phone:828-526-4346
Practice Address - Fax:828-526-2914
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001868363A00000X
NC0010-05321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCR510A194OtherMEDICARE PTAN
MIS86229Medicare UPIN