Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036552 | CT |
Y | 111NI0900X | Internist | 036552 | CT |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036552 | CT |
NPI | 1063492536 |
---|---|
Provider Name | Antonio D.s. Lopez |
First Address | North Haven, CT 06473-1724 |
Second Address | North Haven, CT 06473-1724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004212932 | (05) | CT |
G66990 | (02) | CT |