Basic Information
| Provider Information | |||||||||
| NPI: | 1578653705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC CARDIOLOGY ASSOCIATES OF NEW MEXICO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CEDAR ST SE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058483700 | ||||||||
| FaxNumber: | 5058483703 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 CEDAR ST SE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058483700 | ||||||||
| FaxNumber: | 5058483703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERMAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/PARTNER MD | ||||||||
| AuthorizedOfficialTelephone: | 5058483700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.