Healthcare Provider Details

I. General information

NPI: 1205813920
Provider Name (Legal Business Name): SURESH B NEELAGARU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 US HIGHWAY 84
CHAMA NM
87520-0784
US

IV. Provider business mailing address

2500 US HIGHWAY 84
CHAMA NM
87520-0784
US

V. Phone/Fax

Practice location:
  • Phone: 505-305-7766
  • Fax:
Mailing address:
  • Phone: 505-305-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL4593
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberL4593
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200-0647
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: