Provider Demographics
NPI:1134150774
Name:MANSKE, ERIC STRATMAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:STRATMAN
Last Name:MANSKE
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 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:505-984-1116
Practice Address - Street 1:2055 S PACHECO ST
Practice Address - Street 2:200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3997
Practice Address - Country:US
Practice Address - Phone:505-984-0303
Practice Address - Fax:505-984-1116
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E3236Medicaid
AZ551045Medicaid
H36730Medicare UPIN
TX8HZ066Medicare ID - Type UnspecifiedHSZ006