Healthcare Provider Details

I. General information

NPI: 1801341755
Provider Name (Legal Business Name): RAJARSHI BHADRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3457
US

IV. Provider business mailing address

5981 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3457
US

V. Phone/Fax

Practice location:
  • Phone: 505-370-9600
  • Fax:
Mailing address:
  • Phone: 505-370-9600
  • Fax: 575-627-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2021-0236
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: