Provider Demographics
NPI:1083728554
Name:LOPEZ, NORMA I (DO)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:I
Last Name:LOPEZ
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 1:7 KIMBALL LN STE 1
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2617
Mailing Address - Country:US
Mailing Address - Phone:781-245-6400
Mailing Address - Fax:781-348-6414
Practice Address - Street 1:7 KIMBALL LN STE 1
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2617
Practice Address - Country:US
Practice Address - Phone:781-245-6400
Practice Address - Fax:781-348-6414
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209184207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1031853Medicaid
A31947Medicare ID - Type Unspecified
MA1031853Medicaid