Healthcare Provider Details

I. General information

NPI: 1013268713
Provider Name (Legal Business Name): KENNETH R LIPPMAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 EASTERN AVE
BALTIMORE MD
21224-2115
US

IV. Provider business mailing address

809 N CHARLES ST
BALTIMORE MD
21201-5307
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-1760
  • Fax: 410-284-1763
Mailing address:
  • Phone: 410-752-1532
  • Fax: 410-752-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD27275
License Number StateMD

VIII. Authorized Official

Name: DR. KENNETH ROBERT LIPPMAN
Title or Position: OWNER
Credential: M.D.
Phone: 410-752-1532