Provider Demographics
NPI:1285603340
Name:DEVASTHALI, RAMAKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:RAMAKRISHNA
Middle Name:
Last Name:DEVASTHALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13638
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3638
Mailing Address - Country:US
Mailing Address - Phone:575-449-7005
Mailing Address - Fax:575-449-7006
Practice Address - Street 1:160 S ROADRUNNER PKWY
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7044
Practice Address - Country:US
Practice Address - Phone:575-556-1800
Practice Address - Fax:575-449-7006
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-2122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM010679OtherBCBS & HMO OF NM
P00224034OtherRR MEDICARE
NM05595Medicaid
248520105OtherMEDICARE PTAN
NM201002438OtherPRESBYTERIAN HEALTH
NM05595Medicaid
NM10004975OtherLOVELACE