Healthcare Provider Details

I. General information

NPI: 1972167534
Provider Name (Legal Business Name): JEREMIAH JOHN CAREW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 7600
ALBUQUERQUE NM
87106-4921
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2500
  • Fax: 505-563-2599
Mailing address:
  • Phone: 505-563-2500
  • Fax: 505-563-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL82127
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberDO2025-0039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: