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NPI Code Detail

MEDICARE: ANTONIO D.S. LOPEZ M.D.

MEDICARE: ANTONIO D.S. LOPEZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist036552CT
2207RE0101XEndocrinology, Diabetes & Metabolism Physician036552CT
3207R00000XInternal Medicine Physician036552CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063492536
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO D.S. LOPEZ M.D.
Provider Business Mailing Address
First Line : 52 WASHINGTON AVE
Second Line : SUITE 4
City : NORTH HAVEN
State : CT
Zip : 06473-1724
Country : US
Telephone Number : 203-672-2800
Fax Number : 203-672-2801
Provider Business Practice Location Address
First Line : 52 WASHINGTON AVE
Second Line : SUITE 4
City : NORTH HAVEN
State : CT
Zip : 06473-1724
Country : US
Telephone Number : 203-672-2800
Fax Number : 203-672-2801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 11/06/2012

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