Provider Demographics
NPI:1215362017
Name:DEBORAH MCGREW MD LLC
Entity Type:Organization
Organization Name:DEBORAH MCGREW MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELMONICO
Authorized Official - Suffix:
Authorized Official - Credentials:RRT CPHT
Authorized Official - Phone:505-246-6910
Mailing Address - Street 1:1615 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1717
Mailing Address - Country:US
Mailing Address - Phone:206-353-1942
Mailing Address - Fax:505-792-5222
Practice Address - Street 1:1615 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1717
Practice Address - Country:US
Practice Address - Phone:206-353-1942
Practice Address - Fax:505-792-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty