Healthcare Provider Details

I. General information

NPI: 1184625295
Provider Name (Legal Business Name): MARK ALAN ABRAMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 MONTANA AVE
LAS CRUCES NM
88005-3223
US

IV. Provider business mailing address

299 MONTANA AVE
LAS CRUCES NM
88005-3223
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-4700
  • Fax: 575-527-2204
Mailing address:
  • Phone: 575-523-4700
  • Fax: 575-527-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number94-174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: