Provider Demographics
NPI: | 1538145891 |
---|---|
Name: | LOPES, JOEL R JR (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOEL |
Middle Name: | R |
Last Name: | LOPES |
Suffix: | JR |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 690 CANTON ST |
Mailing Address - Street 2: | SUITE 325 |
Mailing Address - City: | WESTWOOD |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02090-2321 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-407-7713 |
Mailing Address - Fax: | 781-407-0998 |
Practice Address - Street 1: | 690 CANTON ST |
Practice Address - Street 2: | SUITE 325 |
Practice Address - City: | WESTWOOD |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02090-2321 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-407-7713 |
Practice Address - Fax: | 781-407-0998 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-12-19 |
Last Update Date: | 2023-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 75543 | 207LC0200X, 207L00000X |
NY | 320699-01 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 207LC0200X | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 3105521 | Medicaid | |
MA | J13432 | Medicare PIN | |
F48840 | Medicare UPIN |