Provider Demographics
NPI:1083620462
Name:LOPEZ-SHIRLEY, KEVIN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANTONIO
Last Name:LOPEZ-SHIRLEY
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:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-984-4365
Mailing Address - Fax:704-983-7856
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:CAROLINAS HOSPITALIST GROUP - STANLY
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4365
Practice Address - Fax:704-983-7856
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01556208M00000X, 207R00000X
NY202266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749320Medicaid
SCQ0155EMedicaid
NC2023307OtherMEDICARE PTAN
2023307BOtherMEDICARE PTAN, INDIVIDUAL
PA1872287Medicaid
NC5910822Medicaid
G48798Medicare UPIN
NYCC9569Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID #
SCQ0155EMedicaid
NC5910822Medicaid
NY01749320Medicaid