Provider Demographics
NPI:1609126929
Name:LOPES, BLAYNE JOSEPH
Entity Type:Individual
Prefix:MR
First Name:BLAYNE
Middle Name:JOSEPH
Last Name:LOPES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DANUBE ST
Mailing Address - Street 2:1E
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3026
Mailing Address - Country:US
Mailing Address - Phone:508-742-5948
Mailing Address - Fax:
Practice Address - Street 1:88 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management