Healthcare Provider Details

I. General information

NPI: 1326056201
Provider Name (Legal Business Name): SENTHILKUMAR RAMASAMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE SUITE 203
RIO RANCHO NM
87124-4728
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE SUITE 203
RIO RANCHO NM
87124-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-1616
  • Fax: 505-234-1617
Mailing address:
  • Phone: 505-234-1616
  • Fax: 505-234-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2003-0552
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: