Healthcare Provider Details

I. General information

NPI: 1114917283
Provider Name (Legal Business Name): MARIA V LOPEZ-BRESNAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DR. MARIA V LOPEZ

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST NEUROLOGY ASSOCIATES
BOSTON MA
02114-3117
US

IV. Provider business mailing address

PO BOX 9142 MASS. GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8459
  • Fax:
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number59016
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number59016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: