Healthcare Provider Details

I. General information

NPI: 1619902699
Provider Name (Legal Business Name): CHARLES T SPALDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 ROADRUNNER LN NE
ALBUQUERQUE NM
87122-1811
US

IV. Provider business mailing address

657 ROADRUNNER LN NE
ALBUQUERQUE NM
87122-1811
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-7210
  • Fax: 505-272-2349
Mailing address:
  • Phone: 505-856-7210
  • Fax: 505-272-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number76273
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: