1215919261 NPI number — SERGIU STEFANESCU MD

Table of content: SERGIU STEFANESCU MD (NPI 1215919261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215919261 NPI number — SERGIU STEFANESCU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFANESCU
Provider First Name:
SERGIU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215919261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26666
Provider Second Line Business Mailing Address:
PHS PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87125-6666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-923-6770
Provider Business Mailing Address Fax Number:
505-923-5354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 CENTRAL AVE SE FL 4
Provider Second Line Business Practice Location Address:
PMG HOSPITALIST
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-724-6124
Provider Business Practice Location Address Fax Number:
505-724-6125
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  200301178 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD2015-0605 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7985633 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2006408000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 803703 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10038847 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89135E9 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: C9670 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00107272 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 135E9 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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