MEDICARE: DR. STEVEN ELLIS LIPSON D.P.M.

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	213E00000X	Podiatrist	0103000282	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831192335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ELLIS LIPSON D.P.M.

Provider Business Mailing Address
First Line	:	6116 ROLLING RD
Second Line	:	STE116
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-893-6411
Fax Number	:	703-893-6415

Provider Business Practice Location Address
First Line	:	6116 ROLLING RD
Second Line	:	STE 116
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-893-6411
Fax Number	:	703-893-6415

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/12/2011

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