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General NPI Number Information
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NPI Number | 1487334934
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Entity Type | Organization
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Legal Business Name | ADVANCED VASCULAR LLC
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 4501 OSUNA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4467
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Country | US
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Telephone | 505-445-0355
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Fax | 505-531-8914
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Provider Business Mailing Address
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Address Line | 4501 OSUNA RD NE STE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2301
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Country | US
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Telephone | 505-445-0355
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Fax | 505-531-8914
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SATYAKI BANERJEE
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Credential | MD
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Telephone | 505-445-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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