1518173608 NPI number — REENA K RANPURIA MD

Table of content: REENA K RANPURIA MD (NPI 1518173608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518173608 NPI number — REENA K RANPURIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANPURIA
Provider First Name:
REENA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518173608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 GREENWAY CENTER DR
Provider Second Line Business Mailing Address:
STE 930
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-626-6348
Provider Business Mailing Address Fax Number:
866-639-1174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 N JACKSON AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-929-4425
Provider Business Practice Location Address Fax Number:
408-929-4487
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MT179524 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MT179524 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ04539Z . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A995868 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1316099658 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518173608 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ27071Z . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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