Healthcare Provider Details

I. General information

NPI: 1689260671
Provider Name (Legal Business Name): BRANDON A LOPEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

77 S COMMERCE WAY
BETHLEHEM PA
18017-8891
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-4500
  • Fax: 484-526-6674
Mailing address:
  • Phone: 484-526-3571
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062196
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062196
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: