Healthcare Provider Details

I. General information

NPI: 1063506400
Provider Name (Legal Business Name): ADAM NICOL DELU M.D., DABR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5530 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1110 MARQUETTE PL NE
ALBUQUERQUE NM
87106-4703
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2269
  • Fax:
Mailing address:
  • Phone: 832-276-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD2007-0194
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2007-0194
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: