Healthcare Provider Details

I. General information

NPI: 1447259478
Provider Name (Legal Business Name): CHERYL SANDRA LIPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

218 DELAWARE AVE SUITE A
PALMERTON PA
18071-1858
US

IV. Provider business mailing address

218 DELAWARE AVE SUITE A
PALMERTON PA
18071-1858
US

V. Phone/Fax

Practice location:
  • Phone: 610-826-6353
  • Fax: 610-826-6359
Mailing address:
  • Phone: 610-826-6353
  • Fax: 610-826-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037243E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD037243E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: