Provider Demographics
NPI:1174594394
Name:LIPTON, ANDREW B (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:LIPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2204 GRANT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3855
Mailing Address - Country:US
Mailing Address - Phone:650-964-7700
Mailing Address - Fax:650-964-3301
Practice Address - Street 1:2204 GRANT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3855
Practice Address - Country:US
Practice Address - Phone:650-964-7700
Practice Address - Fax:650-964-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G242520Medicare ID - Type Unspecified
CAA42211Medicare UPIN