Basic Information
| Provider Information | |||||||||
| NPI: | 1497734719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHARIA | ||||||||
| FirstName: | SUSHMA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2474 INDIAN WELLS RD | ||||||||
| Address2: | SUITE 2222 | ||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883103845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723120 | ||||||||
| FaxNumber: | 5052728060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MEDICAL ARTS AVE NE | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052726110 | ||||||||
| FaxNumber: | 5052726112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | MD2010-0613 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | MD2010-0613 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 200266380A | 05 | KS | MEDICAID | 207RS0012X | 01 | KS | SLEEP MEDICINE TAXONOMY | OTHER |