Provider Demographics
NPI:1184718579
Name:RIDGEWAY, CALVIN A (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:A
Last Name:RIDGEWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4701 MONTGOMERY BLVD NE
Mailing Address - Street 2:BREAST CARE CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTGOMERY BLVD NE
Practice Address - Street 2:BREAST CARE CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1219
Practice Address - Country:US
Practice Address - Phone:505-727-6900
Practice Address - Fax:505-727-6913
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM94373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56476Medicaid
NM56476Medicaid
341325813Medicare PIN