Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25MA08554200 | NJ |
NPI | 1003050519 |
---|---|
Provider Name | Melissa Lopes |
First Address | Newark, NJ 07101-0406 |
Second Address | Morristown, NJ 07960-6136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162518 | (02) | NJ |