MEDICARE: CHANDRAN VEDAMANIKAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	RS2008-0187	NM
2	202K00000X	Phlebology Physician	MD2012-0121	NM
3	207Q00000X	Family Medicine Physician	MD2012-0121	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154585990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRAN VEDAMANIKAM M.D.

Provider Business Mailing Address
First Line	:	700 S TELSHOR BLVD STE 1460
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8607
Country	:	US
Telephone Number	:	575-567-7774
Fax Number	:	575-205-0306

Provider Business Practice Location Address
First Line	:	3825 EUBANK BLVD NE STE H
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3559
Country	:	US
Telephone Number	:	505-350-3397
Fax Number	:	505-323-7980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	02/09/2026

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