1174858443 NPI number — DR. RADHIKA PRASAD GRANDHE MBBS, FRCA, MD

Table of content: SHANELLE ESTIGOY ARQUERO (NPI 1942155494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174858443 NPI number — DR. RADHIKA PRASAD GRANDHE MBBS, FRCA, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANDHE
Provider First Name:
RADHIKA
Provider Middle Name:
PRASAD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS, FRCA, MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KASETTI
Provider Other First Name:
RADHIKA
Provider Other Middle Name:
JAGANNATHAIAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MBBS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174858443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 BRADBURY DR SE STE 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-1476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIOLOGY MSC10 6000
Provider Second Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-1113
Provider Business Practice Location Address Fax Number:
505-272-1300
Provider Enumeration Date:
10/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  MD2015-0561 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: MD2015-0561 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)