Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 265936 | MA |
NPI | 1659711935 |
---|---|
Provider Name | Dr. Andrew Moss Lippa |
First Address | Brighton, MA 02135-3610 |
Second Address | Collegeville, PA 19426-0989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 05/04/2021 |