Healthcare Provider Details

I. General information

NPI: 1649278672
Provider Name (Legal Business Name): DAVID BUCHWALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5852 MESA VISTA TRL NW
ALBUQUERQUE NM
87120-3297
US

IV. Provider business mailing address

5852 MESA VISTA TRL NW
ALBUQUERQUE NM
87120-3297
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-1673
  • Fax:
Mailing address:
  • Phone: 505-898-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number81-168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: