Provider Demographics
NPI:1568455657
Name:LOPEZ, ANDRE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-1465
Practice Address - Fax:716-250-5989
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY243581-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0114262OtherIHA
NY0281730Medicaid
NY16-1000580OtherEMPIRE
NY16-1000580OtherNORTH AMERICAN PREFERRED
NY000593559003OtherHEALTH NOW
NY00028086801OtherUNIVERA
NY00028086801OtherUNIVERA