| Dermatology Of New Mexico Llc | |
|
610 Broadway Blvd Ne Albuquerque NM 87102-2372 | |
| (505) 225-2500 | |
| (505) 225-2025 |
| Full Name | Dermatology Of New Mexico Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 Broadway Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Suraj2252500 Reddy (CEO / MD) |
| Authorized Official Contact | 5052252500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dermatology Of New Mexico Llc 610 Broadway Blvd Ne Albuquerque NM 87102-2372 Ph: (505) 225-2500 | Dermatology Of New Mexico Llc 610 Broadway Blvd Ne Albuquerque NM 87102-2372 Ph: (505) 225-2500 |
| NPI Number | 1104468438 |
|---|---|
| Provider Enumeration Date | 10/08/2019 |
| Last Update Date | 10/08/2019 |
| Medicare PECOS PAC ID | 6608209606 |
|---|---|
| Medicare Enrollment ID | O20191205001106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104468438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Suraj G Reddy |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1740485275 PECOS PAC ID: 3577623941 Enrollment ID: I20081117000084 |
| Provider Name | Shilpa G Reddy |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1639218639 PECOS PAC ID: 1850583485 Enrollment ID: I20101014000223 |
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