Basic Information
Provider Information
NPI: 1902164536
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEILER
FirstName: MARY
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: MSC 10-5550
Address2: 1 UNIVERSITY OF NEW MEXICO
City: ALBUQUERQUE
State: NM
PostalCode: 87131
CountryCode: US
TelephoneNumber: 5052724661
FaxNumber: 5052724628
Practice Location
Address1: MSC 10-5550
Address2: 1 UNIVERSITY OF NEW MEXICO
City: ALBUQUERQUE
State: NM
PostalCode: 87131
CountryCode: US
TelephoneNumber: 5052724661
FaxNumber: 5052724628
Other Information
ProviderEnumerationDate: 05/02/2012
LastUpdateDate: 10/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD2015-0570NMY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home