Healthcare Provider Details

I. General information

NPI: 1427298520
Provider Name (Legal Business Name): RAMADEVI MEDAVARAPU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4391 E LOHMAN AVE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

4391 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2633
  • Fax:
Mailing address:
  • Phone: 575-522-2633
  • Fax: 575-522-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2014-0595
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: