MEDICARE: NAGA P GRANDHE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	50699	WI
2	390200000X	Student in an Organized Health Care Education/Training Program	MD2015-0752	NM

General Provider Information

NPI Number	:	1700058377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGA P GRANDHE MD

Provider Business Mailing Address
First Line	:	MSC 07 4240, 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-6000
Fax Number	:	505-272-6503

Provider Business Practice Location Address
First Line	:	MSC 07 4240 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-5703
Country	:	US
Telephone Number	:	505-272-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	04/23/2024

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