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General NPI Number Information
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NPI Number | 1508155540
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Entity Type | Individual
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Provider Name | PING PAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 303 ROMA AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2251
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Country | US
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Telephone | 214-402-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 11704 RICHFIELD AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-4025
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Country | US
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Telephone | 214-402-9398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2017-0564
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License Number State | NM
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