Healthcare Provider Details

I. General information

NPI: 1811493018
Provider Name (Legal Business Name): DARIAN SIDDHARTHA DHAWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 10/10/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2796
US

IV. Provider business mailing address

155 N FRESNO ST
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1333
  • Fax: 505-990-3437
Mailing address:
  • Phone: 559-499-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2023-1375
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: