Provider Demographics
NPI:1770775470
Name:LIPETSKAIA, LIOUDMILA (MD)
Entity type:Individual
Prefix:
First Name:LIOUDMILA
Middle Name:
Last Name:LIPETSKAIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 100
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:6102 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-325-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHMT186843207V00000X
NY271723207V00000X
KY43363207VG0400X
NJ25MA10099100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200994620OtherMEDICAID
KY000000675279OtherANTHEM PSC
KY50029780OtherPASSPORT SPECIALITY PSC
KY50029783OtherPASSPORT PCP FOUNDTAION
KY000000632577OtherANTHEM PSC
KYP400021928OtherMEDICARE FOUNDATION
KYP400021928OtherMEDICARE FOUNDATION
KY50029780OtherPASSPORT SPECIALITY PSC
KYP400021928OtherMEDICARE FOUNDATION