Provider Demographics
NPI:1962437020
Name:LOPEZ, ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AMESBURY ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1323
Mailing Address - Country:US
Mailing Address - Phone:978-975-1497
Mailing Address - Fax:
Practice Address - Street 1:101 AMESBURY ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1323
Practice Address - Country:US
Practice Address - Phone:978-975-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52698208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology