Healthcare Provider Details

I. General information

NPI: 1700270873
Provider Name (Legal Business Name): RICHARD D GADOMSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR
SANTA FE NM
87505-4769
US

IV. Provider business mailing address

PO BOX 11
TESUQUE NM
87574-0011
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-0743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD2019-0803
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD2019-0803
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2019-0803
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: