Basic Information
| Provider Information | |||||||||
| NPI: | 1124066824 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FAHY | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 BRADBURY DR SE | ||||||||
| Address2: | SUITE 2222 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723120 | ||||||||
| FaxNumber: | 5052728060 | ||||||||
| Practice Location | |||||||||
| Address1: | UNM CANCER CENTER DEPT OF SURGERY MSC07 4025 | ||||||||
| Address2: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059250456 | ||||||||
| FaxNumber: | 5059250454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | M5153 | TX | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 2086H0002X | MD2013-0237 | NM | Y | Allopathic & Osteopathic Physicians | Surgery | Hospice and Palliative Medicine | 2086X0206X | MD2013-0237 | NM | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8W1055 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 187993402 | 05 | TX | MEDICAID | 187993403 | 05 | TX | MEDICAID | P00427639 | 01 | TX | RAILROAD MEDICARE | OTHER | P01123931 | 01 | TX | RR MEDICARE | OTHER |