Provider Demographics
NPI:1104081074
Name:LOPEZ, PABLO M (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 TOWER PL FL 8
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3714
Mailing Address - Country:US
Mailing Address - Phone:518-489-4471
Mailing Address - Fax:518-489-4506
Practice Address - Street 1:4 TOWER PL FL 8
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3714
Practice Address - Country:US
Practice Address - Phone:518-489-4471
Practice Address - Fax:518-489-4506
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249426207RR0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10137832OtherCDPHP
3005913OtherMVP
7780P1OtherBLUE CROSS
NYJ400000301Medicare PIN