Healthcare Provider Details

I. General information

NPI: 1215362017
Provider Name (Legal Business Name): DEBORAH MCGREW MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1717
US

IV. Provider business mailing address

1615 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1717
US

V. Phone/Fax

Practice location:
  • Phone: 206-353-1942
  • Fax: 505-792-5222
Mailing address:
  • Phone: 206-353-1942
  • Fax: 505-792-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90-246
License Number StateNM

VIII. Authorized Official

Name: MS. MONICA L DELMONICO
Title or Position: CREDENTIALING COORDINATOR
Credential: RRT CPHT
Phone: 505-246-6910