Healthcare Provider Details

I. General information

NPI: 1801854864
Provider Name (Legal Business Name): MARC HENRY STEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PASEO DEL PUEBLO SUR SUITE 150
TAOS NM
87571-6070
US

IV. Provider business mailing address

630 PASEO DEL PUEBLO SUR SUITE 150
TAOS NM
87571-6070
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-3005
  • Fax: 575-758-7010
Mailing address:
  • Phone: 575-758-3005
  • Fax: 575-758-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83-120
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: