Provider Demographics
NPI:1295001048
Name:FATEMI, LIDA (DO)
Entity type:Individual
Prefix:DR
First Name:LIDA
Middle Name:
Last Name:FATEMI
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:MSC 105550
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-4661
Mailing Address - Fax:505-272-4628
Practice Address - Street 1:933 BRADBURY DR SE
Practice Address - Street 2:SUITE 2222
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4374
Practice Address - Country:US
Practice Address - Phone:505-272-3120
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMA187315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine