Provider Demographics
NPI:1639155765
Name:DUARTE, MARCO ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4610 JEFFERSON LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2117
Mailing Address - Country:US
Mailing Address - Phone:505-559-4495
Mailing Address - Fax:505-842-8025
Practice Address - Street 1:4532 N. MESA ST.
Practice Address - Street 2:3RD FLOOR STE 301
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6286
Practice Address - Country:US
Practice Address - Phone:915-317-5077
Practice Address - Fax:505-842-8025
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
TXR4383207V00000X
NM80-141207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00471231OtherRR MEDICARE
NM02923Medicaid
NM02923Medicaid
NMP00471231OtherRR MEDICARE