Provider Demographics
NPI:1023113362
Name:GARY M LOPES MD PC
Entity type:Organization
Organization Name:GARY M LOPES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-232-1120
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 107C
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-232-1120
Mailing Address - Fax:978-232-0110
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 107C
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-232-1120
Practice Address - Fax:978-232-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60604207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048632Medicaid
MA303613OtherHARVARD
060604OtherTUFTS
MA32042OtherFALLON
E33348Medicare UPIN
MAJ09270Medicare ID - Type Unspecified