Provider Demographics
NPI:1730183195
Name:LOPEZ, MARVIN J (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632958
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2958
Mailing Address - Country:US
Mailing Address - Phone:513-451-9698
Mailing Address - Fax:513-451-9699
Practice Address - Street 1:7661 BEECHMONT AVE STE 120
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4234
Practice Address - Country:US
Practice Address - Phone:513-231-9010
Practice Address - Fax:513-231-9706
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080983207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100017243OtherRAILROAD MEDICARE
OH2320447Medicaid
LO4082251Medicare PIN
OH100017243OtherRAILROAD MEDICARE