Provider Demographics
NPI:1952304081
Name:HANUMANDLA, SAROJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAROJANA
Middle Name:
Last Name:HANUMANDLA
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 1:2751 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8726
Mailing Address - Country:US
Mailing Address - Phone:575-434-2965
Mailing Address - Fax:
Practice Address - Street 1:2751 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8726
Practice Address - Country:US
Practice Address - Phone:575-434-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM20020256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33672709Medicaid
NMG60636Medicare UPIN
NM344235003Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE