Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 35.088745 | OH |
Y | 207RH0000X | Hematologist | MD2018-0620 | NM |
NPI | 1316919418 |
---|---|
Provider Name | Leslie A Andritsos |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 30/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2683556 | (05) | OH |
I35346 | (02) | OH |