Provider Demographics
NPI:1073619375
Name:AGUILAR LOPEZ, EDWIN FRANCISCO (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:FRANCISCO
Last Name:AGUILAR LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 HOSPITAL DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4373
Mailing Address - Country:US
Mailing Address - Phone:410-238-5390
Mailing Address - Fax:410-238-5396
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:410-238-5390
Practice Address - Fax:410-238-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409972900 RENDERINGOtherMEDICAL ASSISTANCE
DCF489 0001OtherCAREFIRST
MD424516ZP66OtherMEDICARE
MDFTX6EF 65039006OtherCAREFIRST
1209422OtherAMERICHOICE