Healthcare Provider Details

I. General information

NPI: 1730284548
Provider Name (Legal Business Name): SRICHAND SADHURAM DARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTH HALAGUENO ST SUITE 6
CARLSBAD NM
88220
US

IV. Provider business mailing address

110 SOUTH HALAGUENO ST SUITE 6
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 505-887-6556
  • Fax: 505-234-1206
Mailing address:
  • Phone: 505-887-6556
  • Fax: 505-234-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8228
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: