Provider Demographics
NPI:1831380963
Name:LIPMAN, RUTHANN I (DO)
Entity type:Individual
Prefix:DR
First Name:RUTHANN
Middle Name:I
Last Name:LIPMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W 8TH ST # 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-5007
Mailing Address - Country:US
Mailing Address - Phone:814-864-9994
Mailing Address - Fax:814-866-2655
Practice Address - Street 1:1645 W 8TH ST
Practice Address - Street 2:#106
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5007
Practice Address - Country:US
Practice Address - Phone:814-864-9994
Practice Address - Fax:814-866-2655
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012545207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024075330001Medicaid
170907KYFMedicare PIN