Basic Information
| Provider Information | |||||||||
| NPI: | 1497826978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPMAN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 WILD ROSE DRIVE | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018104619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784751345 | ||||||||
| FaxNumber: | 9784300104 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | 3056143352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 42579 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | 42579 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32328 | 01 | MA | FALLON HEALTH PLAN | OTHER | AA17610 | 01 | MA | HARVARD PILGRIM | OTHER | 0002836 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | B08023 | 01 | MA | BLUE CROSS | OTHER | 3081958 | 05 | MA | MEDICAID | 4196688 | 01 | MA | AETNA HEALTH CARE | OTHER | 042579 | 01 | MA | TUFTS HEALTH PLAN | OTHER |