Healthcare Provider Details

I. General information

NPI: 1467456376
Provider Name (Legal Business Name): ANANDAN SWAMINATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E AZTEC AVE
GALLUP NM
87301-4804
US

IV. Provider business mailing address

PO BOX 8387
ALBUQUERQUE NM
87198-8387
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-2208
  • Fax: 505-863-2236
Mailing address:
  • Phone: 505-841-1000
  • Fax: 505-843-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number98-177
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: