Provider Demographics
NPI:1588777197
Name:LIPP, CARRIE ANN (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:LIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17900 N PORTER RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4228
Mailing Address - Country:US
Mailing Address - Phone:520-233-2500
Mailing Address - Fax:520-233-2531
Practice Address - Street 1:17900 N PORTER RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4228
Practice Address - Country:US
Practice Address - Phone:520-233-2500
Practice Address - Fax:520-233-2531
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529560Medicaid