Provider Demographics
NPI:1164492419
Name:LOPEZ-WARREN, YVETTE M (MD)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:M
Last Name:LOPEZ-WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:L
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37086
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3086
Mailing Address - Country:US
Mailing Address - Phone:240-439-8913
Mailing Address - Fax:240-439-8910
Practice Address - Street 1:1564 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4359
Practice Address - Country:US
Practice Address - Phone:301-663-3137
Practice Address - Fax:301-695-6939
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1977977OtherUNITED
MD403698100Medicaid
MD403698100Medicaid
1977977OtherUNITED