Provider Demographics
NPI:1659320661
Name:RASCHBAUM, LEOPOLD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOPOLD
Middle Name:JOSEPH
Last Name:RASCHBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 COUNTRY CLUB RD
Mailing Address - Street 2:BUILDING A-4
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9757
Mailing Address - Country:US
Mailing Address - Phone:915-820-2362
Mailing Address - Fax:505-589-3021
Practice Address - Street 1:1074 COUNTRY CLUB RD
Practice Address - Street 2:BUILDING A-4
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9757
Practice Address - Country:US
Practice Address - Phone:915-820-2362
Practice Address - Fax:505-589-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-88207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K4535Medicaid
NM000K4535Medicaid
NM345522502Medicare ID - Type Unspecified