Healthcare Provider Details

I. General information

NPI: 1619922622
Provider Name (Legal Business Name): RICHARD A. WACHS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4495
US

IV. Provider business mailing address

2555 MERIDIAN BLVD STE 320
FRANKLIN TN
37067-6670
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 505-265-4033
Mailing address:
  • Phone: 615-665-7115
  • Fax: 615-665-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number25MA075145
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD2016-0029
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: