Provider Demographics
NPI:1083783542
Name:PALMISANO, BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:PALMISANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1631 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4728
Mailing Address - Country:US
Mailing Address - Phone:505-982-7246
Mailing Address - Fax:505-983-4812
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-982-7246
Practice Address - Fax:505-983-4812
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2006-04742081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI24500Medicare UPIN