Provider Demographics
NPI:1205808003
Name:LOPEZ MARTINO, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:LOPEZ MARTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 372
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-457-0063
Mailing Address - Fax:
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:8169 CALLE CONCORDIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1563
Practice Address - Country:US
Practice Address - Phone:787-457-0063
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78272Medicare UPIN
PR0099305Medicare ID - Type Unspecified