Healthcare Provider Details

I. General information

NPI: 1851484570
Provider Name (Legal Business Name): RUTHVEN N SAMPATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2050 SCENIC DR
ALAMOGORDO NM
88310-3880
US

V. Phone/Fax

Practice location:
  • Phone: 575-443-2999
  • Fax: 575-443-6235
Mailing address:
  • Phone: 575-443-2999
  • Fax: 575-443-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number84-253
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: