Provider Demographics
NPI:1285676916
Name:LIPSON, SCOTT R (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:LIPSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 RIVER PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4605
Mailing Address - Country:US
Mailing Address - Phone:916-457-4263
Mailing Address - Fax:916-731-7809
Practice Address - Street 1:1515 RIVER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4605
Practice Address - Country:US
Practice Address - Phone:916-457-4263
Practice Address - Fax:916-457-4213
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0423470001Medicare NSC
CAG57030Medicare UPIN