Healthcare Provider Details

I. General information

NPI: 1093457277
Provider Name (Legal Business Name): MATTHEW ISAAC LIPOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S. 9TH STREET SUITE SUITE 210
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

33 S. 9TH STREET SUITE SUITE 210
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8420
  • Fax:
Mailing address:
  • Phone: 215-955-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD490411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: