Provider Demographics
NPI:1275405201
Name:LOPEZ, MATTHEW (AUD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11418 ROCKVILLE PIKE APT 2104
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-6007
Mailing Address - Country:US
Mailing Address - Phone:240-477-1010
Mailing Address - Fax:240-477-1012
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 105
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3042
Practice Address - Country:US
Practice Address - Phone:240-477-1010
Practice Address - Fax:240-477-1012
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01731231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist