Provider Demographics
NPI:1922042589
Name:LOPEZ, RAMON C (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4303
Mailing Address - Country:US
Mailing Address - Phone:215-462-0501
Mailing Address - Fax:
Practice Address - Street 1:235 N. BROAD STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-568-3510
Practice Address - Fax:215-568-3529
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004244L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00173278700005Medicaid
PAU73028Medicare UPIN
PA021791Medicare ID - Type Unspecified