Provider Demographics
NPI:1720043102
Name:LOPEZ, MARIO M (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:M
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:EDITH NOURSE ROGERS VETERANS MEMORIAL HOSPITAL
Mailing Address - Street 2:200 SPRINGS ROAD
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-2000
Mailing Address - Fax:
Practice Address - Street 1:EDITH NOURSE ROGERS VETERANS MEMORIAL HOSPITAL
Practice Address - Street 2:200 SPRINGS ROAD
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:781-687-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229363208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist