Healthcare Provider Details

I. General information

NPI: 1851445084
Provider Name (Legal Business Name): ARNOLD LANE LECKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7113 PROSPECT PL NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

7113 PROSPECT PL NE
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-5877
  • Fax: 505-883-3275
Mailing address:
  • Phone: 505-883-5877
  • Fax: 505-883-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNM78205
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: