Provider Demographics
NPI:1861600934
Name:LOPEZ DEL CASTILLO, KHARMEN (MD)
Entity type:Individual
Prefix:DR
First Name:KHARMEN
Middle Name:
Last Name:LOPEZ DEL CASTILLO
Suffix:
Gender:F
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 8019
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01102-8000
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:238 NORTHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1000
Practice Address - Country:US
Practice Address - Phone:413-529-9300
Practice Address - Fax:413-527-7517
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA241476OtherCONNECTICARE, INC.
MA110083336AMedicaid