Healthcare Provider Details

I. General information

NPI: 1053315390
Provider Name (Legal Business Name): ROBERT E. FEDERICI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE SUITE 7600
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2624
  • Fax: 505-563-2608
Mailing address:
  • Phone: 505-563-2624
  • Fax: 505-563-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number96-240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: