Healthcare Provider Details

I. General information

NPI: 1700911955
Provider Name (Legal Business Name): ALAN L. LIPMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HILLCREST ST
AUGUSTA ME
04330-6206
US

IV. Provider business mailing address

2 HILLCREST ST
AUGUSTA ME
04330-6206
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-3069
  • Fax:
Mailing address:
  • Phone: 207-623-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD147
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: