Provider Demographics
NPI:1245348416
Name:LOPEZ, NICANOR C (MD)
Entity type:Individual
Prefix:DR
First Name:NICANOR
Middle Name:C
Last Name:LOPEZ
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 1:1736 BRITTANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002
Mailing Address - Country:US
Mailing Address - Phone:440-717-6600
Mailing Address - Fax:
Practice Address - Street 1:1736 BRITTANY DRIVE
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002
Practice Address - Country:US
Practice Address - Phone:609-345-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03604500207P00000X
PAMD037726L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0368398000OtherAMERIHEALTH
NJ60018874OtherHORIZON NJ HEALTH
NJ5114306Medicaid
NJBL4348149OtherDEA
NJ60018874OtherHORIZON NJ HEALTH
NJ550663UKEMedicare ID - Type Unspecified