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General NPI Number Information
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NPI Number | 1114414810
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Entity Type | Individual
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Provider Name | PRANAMYA SURI MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 2100 LOUISIANA BLVD NE STE 410
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5412
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Country | US
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Telephone | 505-724-4300
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Fax | 505-724-4384
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Provider Business Mailing Address
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Address Line | 2100 LOUISIANA BLVD NE STE 410
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5412
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Country | US
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Telephone | 505-724-4300
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Fax | 505-724-4384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD2024-0407
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D94652
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License Number State | MD
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