MEDICARE: DR. SURJIT REDDY MOOLAMALLA 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	01053146A	IN
2	207V00000X	Obstetrics & Gynecology Physician	N8693	TX
3	207Q00000X	Family Medicine Physician	47545	MN
4	207V00000X	Obstetrics & Gynecology Physician	MD2010-0726	NM

General Provider Information

NPI Number	:	1306849310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURJIT REDDY MOOLAMALLA M.D.

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE STE 401
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8261
Country	:	US
Telephone Number	:	575-522-4767
Fax Number	:	575-522-3607

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE
Second Line	:	SUITE 401
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8259
Country	:	US
Telephone Number	:	575-522-4767
Fax Number	:	575-522-3607

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/22/2025

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