Provider Demographics
NPI:1265401830
Name:LIPSCHUTZ, LOUIS B (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:B
Last Name:LIPSCHUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 RIDINGS WAY
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5245
Mailing Address - Country:US
Mailing Address - Phone:610-853-3370
Mailing Address - Fax:215-641-4925
Practice Address - Street 1:175 RIDINGS WAY
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5245
Practice Address - Country:US
Practice Address - Phone:610-853-3370
Practice Address - Fax:215-641-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030120E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010572500006Medicaid
0001758663OtherIBC
192988OtherPA BLUE SHIELD
192988OtherMEDIARE PTAN
0001758663OtherIBC