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General NPI Number Information
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NPI Number | 1497700330
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Entity Type | Individual
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Provider Name | SANJAY K KHOLWADWALA MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10501 GOLF COURSE RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5019
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Country | US
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Telephone | 505-727-2050
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Fax | 505-727-2049
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Provider Business Mailing Address
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Address Line | 10806 PINO AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3432
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Country | US
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Telephone | 505-681-9131
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Fax | 505-821-3773
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 97-288
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License Number State | NM
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