Healthcare Provider Details

I. General information

NPI: 1962578047
Provider Name (Legal Business Name): MARCELO ENRIQUE LOPEZ-CLAROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 FALSTAFF RD
RALEIGH NC
27610-1812
US

IV. Provider business mailing address

105 WHITTSHIRE CT
CARY NC
27513-5581
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-7000
  • Fax:
Mailing address:
  • Phone: 919-817-9147
  • Fax: 919-821-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number33595
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number33595
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: