Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 292172 | NY |
NPI | 1740387190 |
---|---|
Provider Name | Dr. Maricarmen Lopez-Pena |
First Address | Albany, NY 12208-3795 |
Second Address | Albany, NY 12208-3795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 19/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H4661 | (02) |