Provider Demographics
NPI:1497734719
Name:DHARIA, SUSHMA M (MD)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:M
Last Name:DHARIA
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 1:2474 INDIAN WELLS RD
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3845
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE
Practice Address - Street 2:BUILDING 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-272-6110
Practice Address - Fax:505-272-6112
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0613207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266380AMedicaid
KS207RS0012XOtherSLEEP MEDICINE TAXONOMY
KS200266380AMedicaid
F93254Medicare UPIN