Provider Demographics
NPI:1497826978
Name:LIPMAN, EDWARD M (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:67 WILD ROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4619
Mailing Address - Country:US
Mailing Address - Phone:978-475-1345
Mailing Address - Fax:978-430-0104
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:305-614-3352
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA42579207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32328OtherFALLON HEALTH PLAN
MAAA17610OtherHARVARD PILGRIM
MA0002836OtherNEIGHBORHOOD HEALTH PLAN
MAB08023OtherBLUE CROSS
MA3081958Medicaid
MA4196688OtherAETNA HEALTH CARE
MA042579OtherTUFTS HEALTH PLAN
MAB0802302Medicare PIN
MA0002836OtherNEIGHBORHOOD HEALTH PLAN
MA4196688OtherAETNA HEALTH CARE
MAA32105Medicare UPIN