Provider Demographics
NPI:1164482923
Name:DONALDSON, DEIRDRE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MD, PHD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3201
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:UNMHSC 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:DEPT OF NEUROLOGY; MSC 10-5620
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3342
Practice Address - Fax:505-272-6692
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-11-10
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-04082084N0400X
NH185652084N0400X
CT364072084N0400X
VT042-00096192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011427Medicaid
NH3088367Medicaid
VTOVN1743Medicaid