Provider Demographics
NPI:1346245594
Name:STORY, AMANDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:STORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4650 JEFFERSON LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2127
Mailing Address - Country:US
Mailing Address - Phone:505-727-7900
Mailing Address - Fax:505-727-7942
Practice Address - Street 1:4650 JEFFERSON LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2127
Practice Address - Country:US
Practice Address - Phone:505-727-7900
Practice Address - Fax:505-727-7942
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM89-3102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00017723Medicaid
NM920004601OtherMEDICARE RAILROAD
NME62325Medicare UPIN
NM00017723Medicaid
NM17723Medicaid
NMRADIO007Medicare PIN
NME62325Medicare UPIN
NM30147OtherLOVELACE HEALTHPLAN