Provider Demographics
NPI:1982604427
Name:LIPENKO, VALERY N (MD)
Entity type:Individual
Prefix:
First Name:VALERY
Middle Name:N
Last Name:LIPENKO
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 1:1604 HOSPITAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6930
Mailing Address - Country:US
Mailing Address - Phone:817-848-4485
Mailing Address - Fax:817-848-4490
Practice Address - Street 1:1604 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6930
Practice Address - Country:US
Practice Address - Phone:817-848-4485
Practice Address - Fax:817-848-4490
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL64982084N0400X
FLME00866962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00020776OtherRAILROAD MEDICARE
P00734707OtherRAILROAD MEDICARE
TXTPI195912402Medicaid
FL266642100Medicaid
FL266642100Medicaid
57921ZMedicare ID - Type Unspecified
8L7758Medicare PIN