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General NPI Number Information
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NPI Number | 1780660597
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Entity Type | Organization
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Legal Business Name | LUBA TSYPKIN MD LLC
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 198 MASSACHUSETTS AVE
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-4143
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Country | US
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Telephone | 978-975-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 198 MASSACHUSETTS AVE
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-4143
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Country | US
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Telephone | 978-975-2300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUBA TYSPKIN
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Credential | MD
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Telephone | 800-927-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79067
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License Number State | MA
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