Healthcare Provider Details

I. General information

NPI: 1164492419
Provider Name (Legal Business Name): YVETTE M LOPEZ-WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVETTE L WARREN M.D.

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 OPOSSUMTOWN PIKE
FREDERICK MD
21702-4359
US

IV. Provider business mailing address

PO BOX 37086
BALTIMORE MD
21297-3086
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-3137
  • Fax: 301-695-6939
Mailing address:
  • Phone: 240-439-8913
  • Fax: 240-439-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0058726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: