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General NPI Number Information
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NPI Number | 1144370917
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Entity Type | Organization
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Legal Business Name | LORIAN KOSTRANCHUK, MD, LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 CARLISLE BLVD NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5658
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Country | US
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Telephone | 505-232-8950
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Fax | 505-266-8949
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Provider Business Mailing Address
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Address Line | 1400 CARLISLE BLVD NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5658
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Country | US
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Telephone | 505-232-8950
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Fax | 505-266-8949
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORIAN KOSTRANCHUK
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Credential | MD
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Telephone | 505-232-8950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 95-275
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License Number State | NM
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