Provider Demographics
NPI:1053425892
Name:LIPTON, ANDREW MARK (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:LIPTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:822 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-667-4601
Mailing Address - Fax:610-667-6416
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1937
Practice Address - Country:US
Practice Address - Phone:610-667-4601
Practice Address - Fax:610-667-6416
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007794L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA726442Medicare ID - Type Unspecified
PAF39699Medicare UPIN