| Mary L Grebenc, MD | |
| 
					1 Unm, Albuquerque, NM 87131-3616  | |
| (505) 272-2525 | |
| (505) 272-6055 | 
| Full Name | Mary L Grebenc | 
|---|---|
| Gender | Female | 
| Speciality | Radiology - Diagnostic Radiology | 
| Location | 1 Unm, Albuquerque, New Mexico | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1699727347 | NPI | - | NPPES | 
| 00G872330 | Medicaid | CA | |
| 00G872330 | Other | CA | BLUE SHIELD PIN | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | G87233 (California) | Secondary | 
| 2085R0202X | Radiology - Diagnostic Radiology | 90-199 (New Mexico) | Primary | 
| Entity Name | Geisinger Clinic | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1558313023 PECOS PAC ID: 5395657001 Enrollment ID: O20160512002382  | 
| Entity Name | Golden State Imaging Associates Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1144872052 PECOS PAC ID: 1254761315 Enrollment ID: O20200414001788  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Mary L Grebenc, MD 800 Bradbury Dr Se Ste 116, Albuquerque, NM 87106-4310 Ph: (505) 272-1476  | Mary L Grebenc, MD 1 Unm, Albuquerque, NM 87131-3616 Ph: (505) 272-2525  | 
Mark Ehrhart, MD Radiology Medicare: Medicare Enrolled Practice Location: Msc 10 5550, 1 University Of New Mexico, Albuquerque, NM 87131 Phone: 505-272-4661  | |
Dr. Karen Renee Craig, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 2211 Lomas Blvd Ne, Albuquerque, NM 87106 Phone: 505-272-0011  | |
Stuart Bernard Paster,  Radiology Medicare: Not Enrolled in Medicare Practice Location: 8020 Constitution Place Ne, #101, Albuquerque, NM 87110 Phone: 505-998-1317 Fax: 505-998-1308  | |
Danielle Eckart Sorte, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: Dept Of Radiology Msc 10 5530, 1 University Of New Mexico, Albuquerque, NM 87131 Phone: 801-641-5515  | |
Dr. Luis Centenera, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 4411 The 25 Way Ne, Suite 150, Albuquerque, NM 87109 Phone: 505-332-5800 Fax: 505-332-6919  | |
Ryan Craig Lebaron, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: Msc10 5530, 1 University Of New Mexico, Albuquerque, NM 87131 Phone: 505-272-6225  | |
Glenn S. Roush, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 4411 The 25 Way Ne, Albuquerque, NM 87109 Phone: 505-332-6921 Fax: 256-382-6455  |