Provider Demographics
NPI:1194869537
Name:LIPPITT, ROBERT G (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LIPPITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0147
Mailing Address - Country:US
Mailing Address - Phone:919-934-5955
Mailing Address - Fax:919-934-0959
Practice Address - Street 1:507 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4405
Practice Address - Country:US
Practice Address - Phone:919-934-5955
Practice Address - Fax:919-934-0959
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38802208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7952117Medicaid
NCE39838Medicare UPIN
NC7952117Medicaid