Provider Demographics
NPI:1447568811
Name:MARK SEREDOWYCH, MD, PC
Entity Type:Organization
Organization Name:MARK SEREDOWYCH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SEREDOWYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-982-4276
Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-982-4276
Mailing Address - Fax:505-983-7571
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-982-4276
Practice Address - Fax:505-983-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty