Provider Demographics
NPI:1487707675
Name:MARINSEK, THOMAS EDWARD (PA C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:MARINSEK
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 PAN AMERICAN FWY NE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-823-8170
Mailing Address - Fax:505-823-8175
Practice Address - Street 1:6100 PAN AMERICAN FWY NE
Practice Address - Street 2:SUITE 420
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-823-8170
Practice Address - Fax:505-823-8175
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM002232OtherBLUE CROSS BLUE SHIELD
NM22384Medicaid
NMNM002232OtherBLUE CROSS BLUE SHIELD