Provider Demographics
NPI:1568534386
Name:LOPEZ, ADOLFO LOPEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:LOPEZ
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8415 BELLONA LN
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2055
Mailing Address - Country:US
Mailing Address - Phone:410-828-1273
Mailing Address - Fax:410-828-1354
Practice Address - Street 1:8415 BELLONA LANE
Practice Address - Street 2:SUITE 109
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-828-1273
Practice Address - Fax:410-828-1354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0014811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76270Medicare UPIN
MD5472AMedicare ID - Type Unspecified