Healthcare Provider Details

I. General information

NPI: 1366737256
Provider Name (Legal Business Name): MEETA WAGLE CARDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEETA RAVINDRA WAGLE M.D.

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO DEPT OF
ALBUQUERQUE NM
87131-2529
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-272-9351
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberMD2021-0308
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberR3808
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD2021-0308
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR3808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: