Provider Demographics
NPI:1760675870
Name:LOPEZ, GLORIA ESTHELA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ESTHELA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 W AIRY ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4402
Mailing Address - Country:US
Mailing Address - Phone:610-292-9250
Mailing Address - Fax:610-292-9253
Practice Address - Street 1:1024 W AIRY ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4402
Practice Address - Country:US
Practice Address - Phone:610-292-9250
Practice Address - Fax:610-292-9253
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049463L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice