Healthcare Provider Details

I. General information

NPI: 1013707561
Provider Name (Legal Business Name): PRAMODMAN SINGH YADAV M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO, MSC10 5590
ALBUQUERQUE NM
81731
US

IV. Provider business mailing address

801 LOCUST PL NE APT 2016
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2231
  • Fax: 505-272-8098
Mailing address:
  • Phone: 505-410-6053
  • Fax: 505-272-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: