Provider Demographics
NPI:1831192335
Name:LIPSON, STEVEN ELLIS (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ELLIS
Last Name:LIPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 ROLLING RD
Mailing Address - Street 2:STE116
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1521
Mailing Address - Country:US
Mailing Address - Phone:703-893-6411
Mailing Address - Fax:703-893-6415
Practice Address - Street 1:6116 ROLLING RD
Practice Address - Street 2:STE 116
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1521
Practice Address - Country:US
Practice Address - Phone:703-893-6411
Practice Address - Fax:703-893-6415
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9300767Medicaid
T30887Medicare UPIN
VA9300767Medicaid
108939Medicare PIN