Provider Demographics
NPI:1124066824
Name:FAHY, BRIDGET N (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:N
Last Name:FAHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:UNM CANCER CENTER DEPT OF SURGERY MSC07 4025
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-0456
Practice Address - Fax:505-925-0454
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5153208C00000X
NMMD2013-02372086H0002X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187993403Medicaid
TX8W1055OtherBLUE CROSS BLUE SHIELD
TXP01123931OtherRR MEDICARE
TX187993402Medicaid
TXP00427639OtherRAILROAD MEDICARE
TX8L21668Medicare PIN
TXP01123931OtherRR MEDICARE
TX8W1055OtherBLUE CROSS BLUE SHIELD