Healthcare Provider Details

I. General information

NPI: 1659443299
Provider Name (Legal Business Name): MARY LYNNE REUSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE # A SUITE 101
ALBUQUERQUE NM
87109-1210
US

IV. Provider business mailing address

PO BOX 2160
CORRALES NM
87048-2160
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-9687
  • Fax: 505-884-9688
Mailing address:
  • Phone: 505-884-9687
  • Fax: 505-884-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2003 0502
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG33665
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number122409-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2003-0502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: