Provider Demographics
NPI:1649201328
Name:LOPEZ-CARDONA, ALFONSO (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:LOPEZ-CARDONA
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 1:1101 PROFESSIONAL DR # DRIVEC
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3301
Mailing Address - Country:US
Mailing Address - Phone:757-645-3795
Mailing Address - Fax:757-645-3796
Practice Address - Street 1:1101 PROFESSIONAL DRIVE STE C
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-645-3795
Practice Address - Fax:757-645-3796
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012257842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50498Medicare UPIN