Healthcare Provider Details

I. General information

NPI: 1821179391
Provider Name (Legal Business Name): BRIAN STEVEN LIPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MAIN ST. 200
REWOOD CITY CA
94063-1729
US

IV. Provider business mailing address

369 MAIN ST . 200
REDWOOD CITY CA
94063-1729
US

V. Phone/Fax

Practice location:
  • Phone: 650-216-6111
  • Fax:
Mailing address:
  • Phone: 650-216-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG057912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: