Provider Demographics
NPI:1730371410
Name:TANEJA, ANJALI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:
Last Name:TANEJA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ISLETA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4634
Mailing Address - Country:US
Mailing Address - Phone:505-907-8311
Mailing Address - Fax:505-907-8311
Practice Address - Street 1:1608 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4634
Practice Address - Country:US
Practice Address - Phone:505-907-8311
Practice Address - Fax:505-288-3561
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA099730207Q00000X
NMMD2009-0648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84724528Medicaid
NMH3451Medicaid