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General NPI Number Information
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NPI Number | 1376536623
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Entity Type | Individual
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Provider Name | ELISA M. MONTROSS-LOPEZ MD..
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Gender | Female
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 630 MULBERRY STREET
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City | MILTON
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State | DE
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Zip | 19968
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Country | US
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Telephone | 302-684-8053
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Fax | 302-684-8059
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Provider Business Mailing Address
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Address Line | 640 S STATE ST 742 BUILDING
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City | DOVER
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State | DE
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Zip | 19901-3530
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Country | US
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Telephone | 302-674-3970
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Fax | 302-672-2350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C1-0004991
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License Number State | DE
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