Provider Demographics
NPI:1073573507
Name:OCNEANU, TUDOR (MD)
Entity Type:Individual
Prefix:
First Name:TUDOR
Middle Name:
Last Name:OCNEANU
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 1:2904 RODEO PARK DR E STE 300B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6309
Mailing Address - Country:US
Mailing Address - Phone:505-216-3466
Mailing Address - Fax:505-216-3105
Practice Address - Street 1:2904 RODEO PARK DR E STE 300B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6309
Practice Address - Country:US
Practice Address - Phone:505-216-3466
Practice Address - Fax:505-216-3105
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0229207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27332331Medicaid