MEDICARE: EDIBALDO SILVA 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
1	2086X0206X	Surgical Oncology Physician	22537	NE
2	2086X0206X	Surgical Oncology Physician	0101275456	VA

General Provider Information

NPI Number	:	1942315569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDIBALDO SILVA LOPEZ M.D.

Provider Business Mailing Address
First Line	:	13900 CHURCH HILL DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-2131
Country	:	US
Telephone Number	:	703-335-2779
Fax Number	:

Provider Business Practice Location Address
First Line	:	13900 CHURCH HILL DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-2131
Country	:	US
Telephone Number	:	703-335-2779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/17/2024

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