Healthcare Provider Details

I. General information

NPI: 1558315879
Provider Name (Legal Business Name): OSCAR S. LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OSCAR S LOPEZ MD

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 FARBER LAKES DR
WILLIAMSVILLE NY
14221-5773
US

IV. Provider business mailing address

531 FARBER LAKES DR
WILLIAMSVILLE NY
14221-5773
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-5450
  • Fax:
Mailing address:
  • Phone: 716-632-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number098285
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 098285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: