Provider Demographics
NPI:1255360962
Name:KIPERSZTOK, SIMON (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:KIPERSZTOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIMON
Other - Middle Name:
Other - Last Name:KIPERSZTOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-224-5500
Mailing Address - Fax:410-224-4272
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-5500
Practice Address - Fax:410-224-4272
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62580207VE0102X
MDD0041547207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B86037Medicare UPIN
FL68599Medicare ID - Type Unspecified