Provider Demographics
NPI:1184851107
Name:COLOMBO, ELIZABETH SAGE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SAGE
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HOLLY AVE NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2981
Mailing Address - Country:US
Mailing Address - Phone:505-881-1532
Mailing Address - Fax:
Practice Address - Street 1:8810 HOLLY AVE NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2981
Practice Address - Country:US
Practice Address - Phone:505-881-1532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine