Healthcare Provider Details

I. General information

NPI: 1417480062
Provider Name (Legal Business Name): NEEHAR R KUNDURTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC PEDIATRIC EMERGENCY MEDICINE 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9432
  • Fax: 505-272-6503
Mailing address:
  • Phone: 504-899-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD2020-0348
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number342646
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: