Provider Demographics
NPI:1881600443
Name:HAUSWALD, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAUSWALD
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:CANCER CENTER B-44
Mailing Address - Street 2:MSC08 4620
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2525
Mailing Address - Fax:
Practice Address - Street 1:CANCER CENTER B-44
Practice Address - Street 2:MSC08 4620
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82-60207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91082602Medicaid
NM29785Medicaid
AZ112095Medicaid
8HF976Medicare PIN
E12622Medicare UPIN
NM29785Medicaid