Healthcare Provider Details

I. General information

NPI: 1013193135
Provider Name (Legal Business Name): DABNEY LIPSCOMB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY WAYSON PAVILION, SUITE 150
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 62235
BALTIMORE MD
21264-2235
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1199
  • Fax: 443-481-1495
Mailing address:
  • Phone: 443-481-6572
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR196779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: