Provider Demographics
NPI:1831519800
Name:LARA BARKOFF MD PC
Entity type:Organization
Organization Name:LARA BARKOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-934-9104
Mailing Address - Street 1:4123 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1102
Mailing Address - Country:US
Mailing Address - Phone:505-934-9104
Mailing Address - Fax:
Practice Address - Street 1:4123 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-934-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty