Individual
BERNARD M AGBEMADZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PMG HEMATOLOGY/ONCOLOGY, 8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110
(505) 559-6100
(505) 559-6101
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
2002-0192
NM
207RX0202X
Medical Oncology Physician
2002-0192
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50057804
—
NM
Enumeration date
07/08/2006
Last updated
07/20/2021
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