Provider Demographics
NPI:1023188679
Name:ALBUQUERQUE INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:ALBUQUERQUE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:505-314-0748
Mailing Address - Street 1:4101 BLUE RIDGE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4166
Mailing Address - Country:US
Mailing Address - Phone:505-314-0748
Mailing Address - Fax:
Practice Address - Street 1:4121 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-314-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD1175OtherRAILROAD MEDICARE
NM00013372Medicaid
NM019U17OtherBLUE CROSS BLUE SHIELD
NM00013372Medicaid