Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 04-36018 | KS |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD2017-0611 | NM |
NPI | 1255594461 |
---|---|
Provider Name | Manish Dhar Bajracharya |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 17/03/2018 |