Healthcare Provider Details

I. General information

NPI: 1467689273
Provider Name (Legal Business Name): PAULO ANDRES TORRES-LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD
FREDERICKSBURG VA
22401-4453
US

IV. Provider business mailing address

1101 SAM PERRY BLVD SUITE 207
FREDERICKSBURG VA
22401-4467
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-3340
  • Fax: 540-741-3348
Mailing address:
  • Phone: 540-741-3340
  • Fax: 540-741-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number241207
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101251270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: