Provider Demographics
NPI:1174806608
Name:CYNTHIA L. LOPEZ MD PA
Entity type:Organization
Organization Name:CYNTHIA L. LOPEZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-413-2222
Mailing Address - Street 1:845 A JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7200
Mailing Address - Country:US
Mailing Address - Phone:252-413-2222
Mailing Address - Fax:252-413-6171
Practice Address - Street 1:845 A JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7200
Practice Address - Country:US
Practice Address - Phone:252-413-2222
Practice Address - Fax:252-413-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2161363AOtherMCARE PTAN
NC52918OtherBCBS OF NC
NC8952918Medicaid
NCE980824Medicare UPIN