Healthcare Provider Details

I. General information

NPI: 1487707675
Provider Name (Legal Business Name): THOMAS EDWARD MARINSEK PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN FWY NE SUITE 420
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6100 PAN AMERICAN FWY NE SUITE 420
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8170
  • Fax: 505-823-8175
Mailing address:
  • Phone: 505-823-8170
  • Fax: 505-823-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: