Healthcare Provider Details

I. General information

NPI: 1144263054
Provider Name (Legal Business Name): IRAN SADR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE M SADR MD

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1476
  • Fax: 505-272-1212
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD2021-0948
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD69498
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberD69488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: