Provider Demographics
NPI:1649278672
Name:BUCHWALD, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BUCHWALD
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 1:5852 MESA VISTA TRL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3297
Mailing Address - Country:US
Mailing Address - Phone:505-898-1673
Mailing Address - Fax:
Practice Address - Street 1:5852 MESA VISTA TRL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3297
Practice Address - Country:US
Practice Address - Phone:505-898-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-168207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG1464OtherCONSULTEC/GROUP #
NM1649278672Medicaid
TX1263238-04Medicaid
NM16492768672Medicaid
TX1263238-04Medicaid
TXC13904Medicare UPIN
TX1263238-04Medicaid
NM1649278672Medicare Oscar/Certification
NM16492768672Medicaid