Healthcare Provider Details

I. General information

NPI: 1407423056
Provider Name (Legal Business Name): NAGARAJ SANCHITHA HONGANUR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST PARKVIEW MEDICAL CENTER, GME OFFICE
PUEBLO CO
81003
US

IV. Provider business mailing address

400 W 16TH ST PARKVIEW MEDICAL CENTER, GME OFFICE
PUEBLO CO
81003
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberTL0008934
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.48986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: