Provider Demographics
NPI:1174797187
Name:LIPPOLIS CONDON, CHAROLETTE (DO)
Entity type:Individual
Prefix:
First Name:CHAROLETTE
Middle Name:
Last Name:LIPPOLIS CONDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-0086
Mailing Address - Country:US
Mailing Address - Phone:720-984-2679
Mailing Address - Fax:888-344-0395
Practice Address - Street 1:7550 W YALE AVE STE A155
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3476
Practice Address - Country:US
Practice Address - Phone:720-980-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO458862084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89156773Medicaid
CO89156773Medicaid