=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235710831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW BENJAMIN LIPNER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2021
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 HOOKSETT RD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03104-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-441-1076
-----------------------------------------------------
Fax | 603-369-4663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 NEW HAMPSHIRE AVE STE 2
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-2864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-947-6021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 33712
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------