Healthcare Provider Details

I. General information

NPI: 1790096956
Provider Name (Legal Business Name): KATHRYN ANN LIPSCOMB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ANN MARWICK MD

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST STE 203
FAYETTEVILLE NC
28305-5641
US

IV. Provider business mailing address

NMRTC PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
PORTSMOUTH VA
23708
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3220
  • Fax:
Mailing address:
  • Phone: 757-953-2388
  • Fax: 757-953-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101267557
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number61833
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01069942A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2023-03195
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: