Provider Demographics
NPI:1154371912
Name:LOPEZ, MARY RUTH MOTOMAL (MD)
Entity type:Individual
Prefix:DR
First Name:MARY RUTH
Middle Name:MOTOMAL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:233 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3825
Mailing Address - Country:US
Mailing Address - Phone:304-262-8686
Mailing Address - Fax:240-485-0916
Practice Address - Street 1:233 WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3825
Practice Address - Country:US
Practice Address - Phone:304-262-8686
Practice Address - Fax:240-485-0916
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00966052OtherRAIL ROAD MEDICARE
WV3810007064Medicaid
WVP00966052OtherRAIL ROAD MEDICARE