Basic Information
| Provider Information | |||||||||
| NPI: | 1013193135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPSCOMB | ||||||||
| FirstName: | DABNEY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62235 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212642235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816572 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2003 MEDICAL PKWY | ||||||||
| Address2: | WAYSON PAVILION, SUITE 150 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811199 | ||||||||
| FaxNumber: | 4434811495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R196779 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 046613100 | 05 | MD | MEDICAID | X3640006 | 01 | CAREFIRST DC BOWIE | OTHER | N4350007 | 01 | CAREFIRST DC | OTHER | 000974200 | 05 | FL | MEDICAID | 97601602 | 01 | CAREFIRST MD BOWIE | OTHER | 97601601 | 01 | CAREFIRST MD ANNAPOLIS | OTHER | 97601603 | 01 | CAREFIRST MD PRINCE FREDERICK MD | OTHER |