Healthcare Provider Details

I. General information

NPI: 1750657938
Provider Name (Legal Business Name): ANN MARGUERITE LOPEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801
US

IV. Provider business mailing address

620 SAN GABRIEL OVERLOOK E
GEORGETOWN TX
78628-7638
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2200
  • Fax:
Mailing address:
  • Phone: 512-630-6333
  • Fax: 817-735-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS5419
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT018098
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS5419
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: