Provider Demographics
NPI:1003058157
Name:ABDELERAHMAN, KADER TAWFIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:KADER
Middle Name:TAWFIQ
Last Name:ABDELERAHMAN
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 1:500 WALTER ST NE
Mailing Address - Street 2:STE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2534
Mailing Address - Country:US
Mailing Address - Phone:505-727-5910
Mailing Address - Fax:505-727-5939
Practice Address - Street 1:500 WALTER ST NE
Practice Address - Street 2:STE 401
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2534
Practice Address - Country:US
Practice Address - Phone:505-727-5910
Practice Address - Fax:505-727-5939
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
PA207R00000X207R00000X
NMMD2014-01402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00939854Medicaid