MEDICARE: VALERY N LIPENKO MD

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	2084N0400X	Neurology Physician	L6498	TX
2	2084N0400X	Neurology Physician	ME0086696	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00020776	OTHER		RAILROAD MEDICARE
2	P00734707	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1982604427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERY N LIPENKO MD

Provider Business Mailing Address
First Line	:	1604 HOSPITAL PKWY STE 200
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6930
Country	:	US
Telephone Number	:	817-848-4485
Fax Number	:	817-848-4490

Provider Business Practice Location Address
First Line	:	1604 HOSPITAL PKWY STE 200
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6930
Country	:	US
Telephone Number	:	817-848-4485
Fax Number	:	817-848-4490

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	08/19/2022

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Directions to “ VALERY N LIPENKO MD” Practice Location

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