Healthcare Provider Details

I. General information

NPI: 1982650628
Provider Name (Legal Business Name): CRAIG D LIPPITT P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3909
  • Fax: 607-547-6325
Mailing address:
  • Phone: 607-547-3909
  • Fax: 607-547-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: