Provider Demographics
NPI:1205813920
Name:NEELAGARU, SURESH B (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:B
Last Name:NEELAGARU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 US HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0784
Mailing Address - Country:US
Mailing Address - Phone:505-305-7766
Mailing Address - Fax:
Practice Address - Street 1:2500 US HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0784
Practice Address - Country:US
Practice Address - Phone:505-305-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4593207RC0000X, 207RC0001X
NM200-0647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0383Medicare ID - Type Unspecified
H37144Medicare UPIN