Provider Demographics
NPI:1184734618
Name:LIPPMANN, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LIPPMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9835
Mailing Address - Country:US
Mailing Address - Phone:802-334-4120
Mailing Address - Fax:802-334-4123
Practice Address - Street 1:186 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8537
Practice Address - Country:US
Practice Address - Phone:802-334-3520
Practice Address - Fax:802-334-3512
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009877Medicaid
VT394921OtherMVP
VTP00061826OtherRAILROAD MEDICARE
VT00059562OtherBLUE SHIELD
VT800356OtherLADIES FIRST
VT394921OtherMVP
VT1009877Medicaid