Healthcare Provider Details

I. General information

NPI: 1578653705
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY ASSOCIATES OF NEW MEXICO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE SUITE 700
ALBUQUERQUE NM
87106-4905
US

IV. Provider business mailing address

201 CEDAR ST SE SUITE 700
ALBUQUERQUE NM
87106-4905
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3700
  • Fax: 505-848-3703
Mailing address:
  • Phone: 505-848-3700
  • Fax: 505-848-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BERMAN JR.
Title or Position: VICE PRESIDENT/PARTNER MD
Credential: M.D
Phone: 505-848-3700