Provider Demographics
NPI:1457384695
Name:TROTT, JUSTINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINA
Middle Name:A
Last Name:TROTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:901 W ALAMEDA ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1681
Mailing Address - Country:US
Mailing Address - Phone:505-988-8869
Mailing Address - Fax:505-955-9460
Practice Address - Street 1:901 W ALAMEDA ST
Practice Address - Street 2:SUITE 25
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1681
Practice Address - Country:US
Practice Address - Phone:505-988-8869
Practice Address - Fax:505-955-9460
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM 75-260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27004OtherPRESBYTERIAN HEALTH PLAN
NMNM003169OtherBLUE CROSS
NM02915Medicaid
NM02915Medicaid
NM36002Medicare UPIN