Provider Demographics
NPI:1114284445
Name:NEELAGARU, ANASTASIIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIIA
Middle Name:
Last Name:NEELAGARU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3307
Practice Address - Country:US
Practice Address - Phone:505-237-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2024-04-19
Deactivation Date:2020-07-22
Deactivation Code:
Reactivation Date:2020-10-14
Provider Licenses
StateLicense IDTaxonomies
TXR0099207QG0300X
NMMD2022-0189207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114284445Medicaid