Healthcare Provider Details

I. General information

NPI: 1295002780
Provider Name (Legal Business Name): URVIJ MAHENDRAKUMAR MODHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO DEPT. OF ORTHOPEDICS, 2211 LOMAS BLVD NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4107
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD 2014-0017
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD 2014-0017
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: