Provider Demographics
NPI:1730284548
Name:DARA, SRICHAND SADHURAM (MD)
Entity type:Individual
Prefix:DR
First Name:SRICHAND
Middle Name:SADHURAM
Last Name:DARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 SOUTH HALAGUENO ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:505-887-6556
Mailing Address - Fax:505-234-1206
Practice Address - Street 1:110 SOUTH HALAGUENO ST
Practice Address - Street 2:SUITE 6
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:505-887-6556
Practice Address - Fax:505-234-1206
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM8228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39800Medicaid
NM6593Medicare UPIN