Healthcare Provider Details

I. General information

NPI: 1962470633
Provider Name (Legal Business Name): TODD DAVID LIPPHARDT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HOSPITAL DRIVE SUITE 104
HIGHLANDS NC
28741-7622
US

IV. Provider business mailing address

PO BOX 254
SKYLAND NC
28776-0254
US

V. Phone/Fax

Practice location:
  • Phone: 828-526-4346
  • Fax: 828-526-2914
Mailing address:
  • Phone: 828-708-9876
  • Fax: 828-708-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001868
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05321
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: