1417901893 NPI number — DR. MAGALY AURORA LOPEZ-CSORBA DO

Table of content: DR. MAGALY AURORA LOPEZ-CSORBA DO (NPI 1417901893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417901893 NPI number — DR. MAGALY AURORA LOPEZ-CSORBA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-CSORBA
Provider First Name:
MAGALY
Provider Middle Name:
AURORA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ-LAREO
Provider Other First Name:
MAGALY
Provider Other Middle Name:
AURORA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417901893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44641-1310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-875-5625
Provider Business Mailing Address Fax Number:
330-875-5723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 MYERSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44685-9752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-699-3598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34006179 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000375027 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0142107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341779226002 . This is a "MED MUTUAL OF OH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 61641 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 361 . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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