Basic Information
| Provider Information | |||||||||
| NPI: | 1215919261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEFANESCU | ||||||||
| FirstName: | SERGIU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PHS PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
| FaxNumber: | 5059235354 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 CENTRAL AVE SE FL 4 | ||||||||
| Address2: | PMG HOSPITALIST | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057246124 | ||||||||
| FaxNumber: | 5057246125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200301178 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD2015-0605 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7985633 | 01 | AETNA | OTHER | 2006408000 | 05 | WV | MEDICAID | 803703 | 01 | PARTNERS | OTHER | 10038847 | 05 | VA | MEDICAID | 89135E9 | 05 | NC | MEDICAID | C9670 | 01 | MEDCOST | OTHER | P00107272 | 01 | RR MEDICARE | OTHER | 135E9 | 01 | BCBS | OTHER |