Provider Demographics
NPI:1962683029
Name:LOPEZ, CAITLIN CARR (MD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:CARR
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-395-7585
Mailing Address - Fax:413-496-6869
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-395-7585
Practice Address - Fax:413-496-6869
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2688952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA51030OtherCAQH