Provider Demographics
NPI:1174525257
Name:KAPLAN, DAMARA LEE (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:DAMARA
Middle Name:LEE
Last Name:KAPLAN
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BROADWAY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2372
Mailing Address - Country:US
Mailing Address - Phone:505-242-3991
Mailing Address - Fax:505-243-8405
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4397
Practice Address - Country:US
Practice Address - Phone:505-842-8171
Practice Address - Fax:505-246-0684
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-63208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340020618OtherRAILROAD MEDICARE
NMF0134Medicaid
NM348303403Medicare PIN
340020618OtherRAILROAD MEDICARE