Provider Demographics
NPI:1679746879
Name:SANZONE, AJA M (MD)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:M
Last Name:SANZONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 VEGAS VERDES
Mailing Address - Street 2:UNIT 315
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3009
Mailing Address - Country:US
Mailing Address - Phone:917-582-6241
Mailing Address - Fax:
Practice Address - Street 1:1405 VEGAS VERDES
Practice Address - Street 2:UNIT 315
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3009
Practice Address - Country:US
Practice Address - Phone:917-582-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2005032080P0208X
NMMD2011-0009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1216089Medicaid
MS04028532Medicaid
MS04028532Medicaid
LA1216089Medicaid