Healthcare Provider Details

I. General information

NPI: 1043479785
Provider Name (Legal Business Name): STEPHEN ADRIAN LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 WHIPPLE AVE NW
CANTON OH
44720-7616
US

IV. Provider business mailing address

55 ARCH ST SUITE 2 F
AKRON OH
44304-1423
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-2209
  • Fax:
Mailing address:
  • Phone: 330-375-3783
  • Fax: 330-375-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD460956
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number62623
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.134713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: