1013335025 NPI number — CRESENCIANO C LOPEZ MD PA

Table of content: (NPI 1013335025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013335025 NPI number — CRESENCIANO C LOPEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESENCIANO C LOPEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013335025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20725-0639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-317-0020
Provider Business Mailing Address Fax Number:
301-317-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 FRIENDSHIP BLVD
Provider Second Line Business Practice Location Address:
#270
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-215-7347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
CRESENCIANO
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-317-0020

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  D0015793 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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