Provider Demographics
NPI:1831520998
Name:LOPEZ RIVERA, AGAPITO (MD)
Entity type:Individual
Prefix:
First Name:AGAPITO
Middle Name:
Last Name:LOPEZ RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AGAPITO
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7068
Mailing Address - Country:US
Mailing Address - Phone:570-956-9302
Mailing Address - Fax:570-501-8454
Practice Address - Street 1:26 E ELM ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7068
Practice Address - Country:US
Practice Address - Phone:570-956-9302
Practice Address - Fax:570-501-8454
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042067L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology