Individual
DR. JOSE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 FISHER RD STE 3-1, BERLIN, VT 05602-9000
(802) 225-9000
Mailing address
130 FISHER RD UNIT 1, BERLIN, VT 05602-8132
(802) 225-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042-0013453
VT
207Q00000X
Family Medicine Physician
224329
NY
207Q00000X
Family Medicine Physician
MD461662
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02618133
—
NY
Enumeration date
06/15/2006
Last updated
08/25/2022
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