Healthcare Provider Details

I. General information

NPI: 1841751229
Provider Name (Legal Business Name): RICARDO JAVIER LOPEZ HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICARDO JAVIER LOPEZ MD

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR STE 101
ABINGDON VA
24211-7664
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-1777
  • Fax: 276-258-1778
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101285707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: