Individual
ANDREW GROLLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 998-1660
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD2010-0319
NM
208800000X
Urology Physician
25MA08386700
NJ
208800000X
Urology Physician
Primary
MD2010-0319
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45558230
—
NM
01
—
MD2010-0319
NM MEDICAL BOARD LICENSE
NM
Enumeration date
06/11/2008
Last updated
07/21/2022
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