Healthcare Provider Details

I. General information

NPI: 1275111288
Provider Name (Legal Business Name): ASHWINI KOTKAR METKAR MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHWINI CHANDRAKANT KOTKAR MD. MPH

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5046
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-5300
  • Fax: 505-291-5365
Mailing address:
  • Phone: 505-998-1717
  • Fax: 505-998-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2024-0996
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: