Provider Demographics
NPI:1881685303
Name:DELIGTISCH, AMANDA L (MD)
Entity Type:Individual
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First Name:AMANDA
Middle Name:L
Last Name:DELIGTISCH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:MSC10 5620 1 UNIVERSITY OF NM
Mailing Address - Street 2:THE UNIVERSITY OF NEW MEXICO, DEPT OF NEUROLOGY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-3160
Mailing Address - Fax:505-272-9427
Practice Address - Street 1:MSC10 5620 1 UNIVERSITY OF NM
Practice Address - Street 2:THE UNIVERSITY OF NEW MEXICO, DEPT OF NEUROLOGY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3160
Practice Address - Fax:505-272-9427
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-07-13
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Provider Licenses
StateLicense IDTaxonomies
NMMD2006-05342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74537547Medicaid
I00480Medicare UPIN
343628703Medicare PIN