Healthcare Provider Details

I. General information

NPI: 1831520998
Provider Name (Legal Business Name): AGAPITO LOPEZ RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AGAPITO LOPEZ M.D.

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E ELM ST
HAZLETON PA
18201-7068
US

IV. Provider business mailing address

26 E ELM ST
HAZLETON PA
18201-7068
US

V. Phone/Fax

Practice location:
  • Phone: 570-956-9302
  • Fax: 570-501-8454
Mailing address:
  • Phone: 570-956-9302
  • Fax: 570-501-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD042067L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: