Healthcare Provider Details

I. General information

NPI: 1336128404
Provider Name (Legal Business Name): JOHN LIPPERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

2726 VAN CLIBURN CIR
MIDDLETOWN DE
19709-3201
US

V. Phone/Fax

Practice location:
  • Phone: 614-309-8447
  • Fax:
Mailing address:
  • Phone: 614-309-8447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35078048
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD068392L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier300114509
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRR MEDICARE
# 2
Identifier2181811
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: