Healthcare Provider Details

I. General information

NPI: 1487714804
Provider Name (Legal Business Name): ALWYN AJITRAJ KOIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

IV. Provider business mailing address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-9570
  • Fax: 505-883-4163
Mailing address:
  • Phone: 505-883-9570
  • Fax: 505-883-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2003-0567
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: