Provider Demographics
NPI:1144243890
Name:BUDHWAR, NITIN (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:
Last Name:BUDHWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:5920 FOREST PARK RD STE 601
Practice Address - Street 2:UT SOUTHWESTERN/PARKLAND FAMILY MEDICINE CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6411
Practice Address - Country:US
Practice Address - Phone:214-266-0312
Practice Address - Fax:214-266-0330
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2020-0302207QG0300X
TXM6548207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH80246Medicare UPIN