Basic Information
| Provider Information | |||||||||
| NPI: | 1447259478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPSON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | SANDRA | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 218 DELAWARE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PALMERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180711858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108266353 | ||||||||
| FaxNumber: | 6108266359 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 DELAWARE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PALMERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180711858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108266353 | ||||||||
| FaxNumber: | 6108266359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/20/2006 | ||||||||
| NPIReactivationDate: | 03/27/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD037243E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD037243E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | LI101650 | 01 | PA | BLUE SHIELD IDIV.NUMBER | OTHER | 002660 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 02292600 | 01 | PA | CAPITAL BLUE CROSS GRP. # | OTHER | 001258810 | 05 | PA | MEDICAID | 001642680 | 05 | PA | MEDICAID | 390004526 | 01 | PA | RAILROAD MEDICARE ID. NUM | OTHER | CA869935 | 01 | PA | BLUE SHIELD GRP. NUMBER | OTHER | P1607796 | 01 | PA | OXFORD HEALTH PLAN | OTHER | 01046401 | 01 | PA | CAPITAL BLUE CROSS ID. | OTHER | 020286200 | 01 | PA | FEDERAL BLACK LUNG | OTHER | CE2338 | 01 | PA | RAILROAD MEDICARE GRP.NUM | OTHER |