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NPI Code Detail

MEDICARE: EDDIE RODRIGUEZ-LOPEZ M.D.

MEDICARE: EDDIE RODRIGUEZ-LOPEZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD24682OR
2207Q00000XFamily Medicine PhysicianM-8868ID
3207Q00000XFamily Medicine PhysicianMD420300PA

General Provider Information

NPI Number : 1457352221
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDDIE RODRIGUEZ-LOPEZ M.D.
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-9800
Country : US
Telephone Number : 570-271-6144
Fax Number : 570-271-6578
Provider Business Practice Location Address
First Line : 955 BELLEFONTE AVE
Second Line :
City : LOCK HAVEN
State : PA
Zip : 17745-3033
Country : US
Telephone Number : 570-748-7714
Fax Number : 570-893-6325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/12/2020

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