Provider Demographics
NPI:1588758957
Name:CECHANOWICZ, BARBARA G (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:G
Last Name:CECHANOWICZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2745
Mailing Address - Country:US
Mailing Address - Phone:505-272-2517
Mailing Address - Fax:505-272-9032
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-2517
Practice Address - Fax:505-272-9032
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA20040056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65401743Medicaid
P26400Medicare UPIN
NM65401743Medicaid