Individual
DR. ELLEN J MARDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
UNM CLINICAL NEUROSCIENCE CENTER 2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87131-0001
(505) 272-3160
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
NM 84-73
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142097801
—
TX
01
—
752919329
TAX ID
TX
Enumeration date
09/05/2006
Last updated
09/19/2014
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