Basic Information
| Provider Information | |||||||||
| NPI: | 1396730800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPSON | ||||||||
| FirstName: | SONIA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 NEPONSET AVENUE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172823200 | ||||||||
| FaxNumber: | 6172659719 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 NEPONSET AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021223134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172823200 | ||||||||
| FaxNumber: | 6172659719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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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 | 363L00000X | 159915 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1303775 | 05 | MA | MEDICAID |