Healthcare Provider Details

I. General information

NPI: 1508060351
Provider Name (Legal Business Name): CORINN MELISSA SADLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINN MELISSA CHIVINGTON-BUCK MD

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HIGH RESORT BLVD SE
ALBUQUERQUE NM
87124
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-6400
  • Fax: 505-559-6488
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number51433
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD2018-0156
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: