Provider Demographics
NPI:1659443299
Name:REUSS, MARY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNNE
Last Name:REUSS
Suffix:
Gender:F
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:PO BOX 2160
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2160
Mailing Address - Country:US
Mailing Address - Phone:505-884-9687
Mailing Address - Fax:505-884-9688
Practice Address - Street 1:4600 MONTGOMERY BLVD NE # A
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1210
Practice Address - Country:US
Practice Address - Phone:505-884-9687
Practice Address - Fax:505-884-9688
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003 0502207V00000X
CAG33665207V00000X
NY122409-1207V00000X
NM2003-0502207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP-12036477OtherMULTIPLAN HEALTH PLAN
NM900117328-006OtherCIGNA HEALTH PLAN
NM009L79OtherBCBS PROVIDER NO.
NM900117328 87109 A001OtherTRICARE HEALTH PLAN
NM00NM009L79OtherHMO NEW MEXICO BCBS
NM53157532Medicaid
NMP-12036477OtherMULTIPLAN HEALTH PLAN
NM009L79OtherBCBS PROVIDER NO.