Healthcare Provider Details

I. General information

NPI: 1962419903
Provider Name (Legal Business Name): PATRICK J ABBOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ALAMO AVE SE ADDICTION AND SUBSTANCE ABUSE PROGRAMS
ALBUQUERQUE NM
87106-3204
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-2400
  • Fax:
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number83-144
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: