Provider Demographics
NPI:1013193135
Name:LIPSCOMB, DABNEY (NP)
Entity Type:Individual
Prefix:
First Name:DABNEY
Middle Name:
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:NP
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 62235
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2235
Mailing Address - Country:US
Mailing Address - Phone:443-481-6572
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:WAYSON PAVILION, SUITE 150
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:443-481-1199
Practice Address - Fax:443-481-1495
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196779363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD046613100Medicaid
X3640006OtherCAREFIRST DC BOWIE
N4350007OtherCAREFIRST DC
FL000974200Medicaid
97601602OtherCAREFIRST MD BOWIE
97601601OtherCAREFIRST MD ANNAPOLIS
97601603OtherCAREFIRST MD PRINCE FREDERICK MD
FL000974200Medicaid
MD228091Y5ZMedicare PIN
97601603OtherCAREFIRST MD PRINCE FREDERICK MD
MD046613100Medicaid