Provider Demographics
NPI:1558315879
Name:LOPEZ, OSCAR S (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:S
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:S
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:531 FARBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5773
Mailing Address - Country:US
Mailing Address - Phone:716-632-5450
Mailing Address - Fax:
Practice Address - Street 1:531 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5773
Practice Address - Country:US
Practice Address - Phone:716-632-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0982852084P0800X
NYMD 0982852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00594876Medicaid
B71249Medicare UPIN
NY00594876Medicaid