Healthcare Provider Details

I. General information

NPI: 1053546796
Provider Name (Legal Business Name): SIAVASH KARIMIAN MD OF NEW MEXICO PC DBA ROSWELL MEDICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 N. WASHINGTON AVE
ROSWELL NM
88201
US

IV. Provider business mailing address

PO BOX 1617
ROSWELL NM
88202-1617
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-8430
  • Fax: 575-625-8452
Mailing address:
  • Phone: 575-625-8430
  • Fax: 575-625-8452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number143171
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD2011-0412
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2007-0234
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2001-PA31
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP02096
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP001177
License Number StateNM

VIII. Authorized Official

Name: MR. SIAVASH KARIMIAN
Title or Position: PRESIDENT/OWENR
Credential: MD
Phone: 575-625-8430