Provider Demographics
NPI:1851484570
Name:SAMPATH, RUTHVEN N (MD)
Entity Type:Individual
Prefix:
First Name:RUTHVEN
Middle Name:N
Last Name:SAMPATH
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 1:2050 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3880
Mailing Address - Country:US
Mailing Address - Phone:575-443-2999
Mailing Address - Fax:575-443-6235
Practice Address - Street 1:2669 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8700
Practice Address - Country:US
Practice Address - Phone:575-443-2999
Practice Address - Fax:575-443-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-253207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0034082Medicaid
F38413Medicare UPIN
NM343434501Medicare ID - Type Unspecified