Healthcare Provider Details

I. General information

NPI: 1770677759
Provider Name (Legal Business Name): KENNETH ROBERT LIPPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N CHARLES STREET
BALTIMORE MD
21201-5335
US

IV. Provider business mailing address

809 N CHARLES STREET
BALTIMORE MD
21201-5335
US

V. Phone/Fax

Practice location:
  • Phone: 410-752-1532
  • Fax: 410-752-7025
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 NumberD0027275
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME43996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: