MEDICARE: DR. GLADYS HELENA LOPEZ MD

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
1	207P00000X	Emergency Medicine Physician	66322	AZ
2	207P00000X	Emergency Medicine Physician	D0061799	MD
3	207P00000X	Emergency Medicine Physician	75126	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1336117589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADYS HELENA LOPEZ MD

Provider Business Mailing Address
First Line	:	900 CATON AVE
Second Line	:	ST. AGNES HOSPITAL EMERGENCY DEPARTMENT
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5201
Country	:	US
Telephone Number	:	410-368-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 W STATE ROUTE 89A
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86336-4937
Country	:	US
Telephone Number	:	928-204-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/19/2025

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Directions to “ DR. GLADYS HELENA LOPEZ MD” Practice Location

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