Provider Demographics
NPI:1184637399
Name:LOPEZ, LENNY (MD MDIV)
Entity Type:Individual
Prefix:
First Name:LENNY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SHATTUCK ST
Mailing Address - Street 2:HARVARD MEDICAL SCHOOL, DEPARTMENT OF MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6027
Mailing Address - Country:US
Mailing Address - Phone:617-732-6660
Mailing Address - Fax:
Practice Address - Street 1:1620 TREMONT ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-732-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine