Provider Demographics
NPI:1356662670
Name:MEDORO, AMANDA K (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:MEDORO
Suffix:
Gender:F
Credentials:MD
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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:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO MSC11 6025
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-5062
Practice Address - Fax:505-925-7290
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2023-11-29
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Provider Licenses
StateLicense IDTaxonomies
CT54129207P00000X
NMMD2049-0999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine