Healthcare Provider Details

I. General information

NPI: 1063288934
Provider Name (Legal Business Name): CARLA MELISA LITUMA LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIVERSIDE AVE
BRISTOL CT
06010-6312
US

IV. Provider business mailing address

54 GRANT AVE
STAMFORD CT
06902-4157
US

V. Phone/Fax

Practice location:
  • Phone: 860-516-7593
  • Fax: 860-516-7597
Mailing address:
  • Phone: 203-952-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83961
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: