Provider Demographics
NPI:1578653705
Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF NEW MEXICO PC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF NEW MEXICO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/PARTNER MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:505-848-3700
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4905
Mailing Address - Country:US
Mailing Address - Phone:505-848-3700
Mailing Address - Fax:505-848-3703
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:SUITE 700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4905
Practice Address - Country:US
Practice Address - Phone:505-848-3700
Practice Address - Fax:505-848-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2370556Medicare ID - Type Unspecified