Provider Demographics
NPI:1487660650
Name:LOPICCOLO, CHARLES J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:LOPICCOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:251 HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5453
Mailing Address - Country:US
Mailing Address - Phone:954-491-5565
Mailing Address - Fax:954-966-4850
Practice Address - Street 1:8401 S PALM DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4537
Practice Address - Country:US
Practice Address - Phone:954-518-4080
Practice Address - Fax:954-966-4850
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME600312084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3769747-00Medicaid
FLF37174Medicare UPIN
FL3769747-00Medicaid