Provider Demographics
NPI:1497214761
Name:VARADA, NEILMEGH LAKSHMAN (DO)
Entity type:Individual
Prefix:
First Name:NEILMEGH
Middle Name:LAKSHMAN
Last Name:VARADA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC10 5550 1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4661
Mailing Address - Fax:505-272-0475
Practice Address - Street 1:MSC10 5550 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-2632
Practice Address - Country:US
Practice Address - Phone:505-272-4661
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2024-0043390200000X
NVDO3150207R00000X
LA338022208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA338022OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS
NVDO3150OtherNV MEDICAL BOARD OF OSTEOPATHIC MEDICINE
NMRS2024-0043OtherNEW MEXICO MEDICAL BOARD