MEDICARE: DR. PERSIO DAVID LOPEZ LOYO 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	207R00000X	Internal Medicine Physician	294648	NY
2	207RC0000X	Cardiovascular Disease Physician	294648	NY
3	208M00000X	Hospitalist Physician	294648	NY
4	207RI0011X	Interventional Cardiology Physician	294648	NY

General Provider Information

NPI Number	:	1629454467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERSIO DAVID LOPEZ LOYO MD

Provider Business Mailing Address
First Line	:	1041 3RD AVE STE 201
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-8114
Country	:	US
Telephone Number	:	212-319-3977
Fax Number	:	212-721-0806

Provider Business Practice Location Address
First Line	:	385 FORT WASHINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-6740
Country	:	US
Telephone Number	:	212-319-3977
Fax Number	:	212-721-0806

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	07/17/2024

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