Provider Demographics
NPI:1447447123
Name:LIPOF, TAMAR (MD)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:LIPOF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:STE 106P
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-9226
Mailing Address - Fax:978-922-9203
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:STE 106P
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-9226
Practice Address - Fax:978-922-9203
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA244786208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
479390OtherTUFTS
MA110086605AMedicaid
0613057OtherNHP
94356702OtherNETWORK HEALTH