Healthcare Provider Details

I. General information

NPI: 1447238159
Provider Name (Legal Business Name): ANDREW LANGSAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ZAFARANO DR SUITE C
SANTA FE NM
87507-2669
US

IV. Provider business mailing address

3450 ZAFARANO DR SUITE C
SANTA FE NM
87507-2669
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-5885
  • Fax: 505-466-5886
Mailing address:
  • Phone: 505-466-5885
  • Fax: 505-466-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD2010-0670
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: