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General NPI Number Information
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NPI Number | 1477647840
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Entity Type | Individual
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Provider Name | TUSHAR P DANDADE MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 2400 UNSER BLVD SE SUITE 18200
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City | RIO RANCHO
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State | NM
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Zip | 87124-4740
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Country | US
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Telephone | 505-253-6200
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Fax | 505-253-6201
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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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 | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 20030526
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 2003-0526
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License Number State | NM
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