MEDICARE: DR. MARK STEVEN LIPIAN M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	G064116	CA
2	2084P0800X	Psychiatry Physician	G064116	CA
3	2084P0804X	Child & Adolescent Psychiatry Physician	G064116	CA

General Provider Information

NPI Number	:	1194987339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEVEN LIPIAN M.D., PH.D.

Provider Business Mailing Address
First Line	:	2029 CENTURY PARK EAST
Second Line	:	SUITE 2890
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2901
Country	:	US
Telephone Number	:	310-203-3919
Fax Number	:	310-203-3924

Provider Business Practice Location Address
First Line	:	2029 CENTURY PARK EAST
Second Line	:	SUITE 2890
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2901
Country	:	US
Telephone Number	:	310-203-3919
Fax Number	:	310-203-3924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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