Provider Demographics
NPI:1144218892
Name:GERENCER, ROLAND ZSOLT (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:ZSOLT
Last Name:GERENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 TIJERAS AVE NE
Mailing Address - Street 2:STE 22
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-858-8503
Mailing Address - Fax:505-848-8077
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4397
Practice Address - Country:US
Practice Address - Phone:505-842-8171
Practice Address - Fax:505-246-0684
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM99-208207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014203OtherGBA PALMETTO - RAILROAD MEDICARE
NM201021487OtherPRESBYTERIAN HEALTH PLAN
NMNM024902OtherBCBS
NMZ6104Medicaid
NMZ6104Medicaid
040014203OtherGBA PALMETTO - RAILROAD MEDICARE