Healthcare Provider Details

I. General information

NPI: 1417982349
Provider Name (Legal Business Name): ALICE MAROSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE MAROSI CSEPREGI

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7026
  • Fax:
Mailing address:
  • Phone: 505-262-7594
  • Fax: 505-262-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number72-193
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: