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General NPI Number Information
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NPI Number | 1154585990
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Entity Type | Individual
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Provider Name | CHANDRAN VEDAMANIKAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 909 N DATE ST STE B
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City | TRUTH OR CONSEQUENCES
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State | NM
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Zip | 87901-1747
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Country | US
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Telephone | 575-636-2388
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Fax | 575-680-2591
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Provider Business Mailing Address
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Address Line | PO BOX 2707
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City | LAS CRUCES
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State | NM
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Zip | 88004-2707
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Country | US
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Telephone | 575-526-3625
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Fax | 575-526-7112
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RS2008-0187
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2012-0121
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | MD2012-0121
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License Number State | NM
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