Provider Demographics
NPI:1306849310
Name:MOOLAMALLA, SURJIT REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:REDDY
Last Name:MOOLAMALLA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-522-4767
Mailing Address - Fax:575-522-3607
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-522-4767
Practice Address - Fax:575-522-3607
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN47545207Q00000X
IN01053146A207Q00000X
TXBP10025761207V00000X
NMMD2010-0726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine