Provider Demographics
NPI:1740353077
Name:LIPSON, WAYNE E (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:LIPSON
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83852174400000X
WV02113208G00000X
KY44161208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000289341OtherUNISON
OH3002128Medicaid
KYP01080042OtherRR MEDICARE TROVER
WV5104835OtherCIGNA
WV3810015990Medicaid
KY7100122730Medicaid
WV7921468OtherAETNA
FLH57148Medicare UPIN
WVP00768190Medicare PIN
WV7921468OtherAETNA
KY7100122730Medicaid
KYK045741Medicare PIN
OH3002128Medicaid