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NPI Code Detail

MEDICARE: DR. ANDRE L LOPEZ MD

MEDICARE: DR. ANDRE L 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
1207Q00000XFamily Medicine Physician243581-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10114262OTHERNYIHA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
316-1000580OTHERNYEMPIRE
416-1000580OTHERNYNORTH AMERICAN PREFERRED
5000593559003OTHERNYHEALTH NOW
600028086801OTHERNYUNIVERA

General Provider Information

NPI Number : 1568455657
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDRE L LOPEZ MD
Provider Business Mailing Address
First Line : 425 ESSJAY RD STE 170
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8235
Country : US
Telephone Number : 716-630-1219
Fax Number : 716-817-1726
Provider Business Practice Location Address
First Line : 325 ESSJAY RD
Second Line : SUITE 110
City : WILLIAMSVILLE
State : NY
Zip : 14221-8243
Country : US
Telephone Number : 716-630-1465
Fax Number : 716-250-5989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 12/20/2021

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