Provider Demographics
NPI:1649459793
Name:LIPTZIN, MYRON BENNETT (MD)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:BENNETT
Last Name:LIPTZIN
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 1:215 FRIENDLY LANE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3524
Mailing Address - Country:US
Mailing Address - Phone:919-932-1111
Mailing Address - Fax:919-933-6669
Practice Address - Street 1:215 FRIENDLY LANE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-3524
Practice Address - Country:US
Practice Address - Phone:919-932-1111
Practice Address - Fax:919-933-6669
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C85171Medicare UPIN