Individual
JUANITO F. LOPEZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1012 EDGEWOOD RD, EDGEWOOD, MD 21040-1606
(410) 671-7300
(410) 671-7312
Mailing address
1012 EDGEWOOD RD, EDGEWOOD, MD 21040-1606
(410) 671-7300
(410) 671-7312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D14130
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367561102
—
MD
Enumeration date
09/27/2005
Last updated
01/05/2012
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