Individual ProviderMabel LopezInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address56 Franklin St Ste 1, Waterbury, CT 06706-1281(203) 709-6000PECOS EnrollmentBased on the most recent information from CMS, provider Mabel Lopez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1720668098Provider TypeIndividualFull NameLopez, MabelCredentialMDGenderFemaleSole ProprietorNoEnumeration Date4/12/2021Last Updated6/18/2024Contact InformationPractice LocationPractice Address56 Franklin St Ste 1, Waterbury, CT 06706-1281Phone(203) 709-6000FaxUnlisted FaxMailing LocationMailing Address56 Franklin St Ste 1, Waterbury, CT 06706-1281Phone(203) 709-6000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense77776ConnecticutCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerConnecticutProvider IdentifiersIDDescriptionIssuerID06-0646844DescriptionMedicaidIssuerUnlistedConnecticut