Provider Demographics
NPI:1336108596
Name:LOPEZ, ALVARO B (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 SOUTH ST
Mailing Address - Street 2:APT 37
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-836-8984
Mailing Address - Fax:508-836-8984
Practice Address - Street 1:21 SOUTH ST
Practice Address - Street 2:APT 37
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1641
Practice Address - Country:US
Practice Address - Phone:508-836-8984
Practice Address - Fax:508-836-8984
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA414072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9884OtherBCBS
VO5361OtherBCBS
MO9884OtherBCBS
MO9884Medicare ID - Type Unspecified