Healthcare Provider Details

I. General information

NPI: 1154565539
Provider Name (Legal Business Name): JOSHU ALAN RAITEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

4824 MCMAHON BLVD NW STE 109
ALBUQUERQUE NM
87114-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7177
  • Fax: 505-727-3778
Mailing address:
  • Phone: 505-588-7246
  • Fax: 505-551-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD20140514
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD20140514
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: