Provider Demographics
NPI:1780790683
Name:LIPTON, MARC BRUCE (PHD, MPA)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:BRUCE
Last Name:LIPTON
Suffix:
Gender:M
Credentials:PHD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 REISTERSTOWN RD.
Mailing Address - Street 2:COMMERCE CENTER EAST, SUITE 288
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-484-9400
Mailing Address - Fax:410-484-9401
Practice Address - Street 1:1777 REISTERSTOWN RD.
Practice Address - Street 2:COMMERCE CENTER EAST, SUITE 288
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-9400
Practice Address - Fax:410-484-9401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD735400200Medicaid