Healthcare Provider Details

I. General information

NPI: 1477937076
Provider Name (Legal Business Name): GURU THANGAVELU M RAMAIAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GURU THANGAVELU MALAYAPPANPILLAI RAMAIAH M.D.

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-6124
  • Fax: 505-724-6125
Mailing address:
  • Phone: 505-724-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD2025-0127
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: