Provider Demographics
NPI:1154893766
Name:DROZ LOPEZ, AISHA EDITH (MD)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:EDITH
Last Name:DROZ LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:E
Other - Last Name:DROZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:464 CONGRESS AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1362
Mailing Address - Country:US
Mailing Address - Phone:203-785-2353
Mailing Address - Fax:
Practice Address - Street 1:464 CONGRESS AVE STE 260
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1362
Practice Address - Country:US
Practice Address - Phone:203-785-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT78881207P00000X
FLME162249207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118214600Medicaid