Provider Demographics
NPI:1083834030
Name:SUZANNE MARIE PINON MD LLC
Entity Type:Organization
Organization Name:SUZANNE MARIE PINON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PINON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-797-2724
Mailing Address - Street 1:8400 MENAUL BLVD NE
Mailing Address - Street 2:SUITE A-141
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2260
Mailing Address - Country:US
Mailing Address - Phone:505-797-2724
Mailing Address - Fax:505-797-2724
Practice Address - Street 1:8400 MENAUL BLVD NE
Practice Address - Street 2:SUITE A-141
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2260
Practice Address - Country:US
Practice Address - Phone:505-797-2724
Practice Address - Fax:505-797-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-357207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG34849Medicare UPIN