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General NPI Number Information
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NPI Number | 1184816118
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Entity Type | Organization
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Legal Business Name | EMIGDIO A. LOPEZ, JR, M.D., P.C.
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 8346 TRAFORD LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152
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Country | US
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Telephone | 703-451-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 ROLLING RD SUITE #216
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City | SPRINGFIELD
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State | VA
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Zip | 22152
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Country | US
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Telephone | 703-451-3245
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMIGDIO A. LOPEZ
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Credential | M.D.
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Telephone | 703-451-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0101-031554
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License Number State | VA
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