1619023231 NPI number — DR. ASHUTOSH SHYAM RANGOLE MD

Table of content: DR. ASHUTOSH SHYAM RANGOLE MD (NPI 1619023231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619023231 NPI number — DR. ASHUTOSH SHYAM RANGOLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANGOLE
Provider First Name:
ASHUTOSH
Provider Middle Name:
SHYAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1619023231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 S MONACO ST
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-696-2131
Provider Business Mailing Address Fax Number:
303-696-9151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1421 S POTOMAC ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-696-2131
Provider Business Practice Location Address Fax Number:
303-696-9151
Provider Enumeration Date:
01/26/2007

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: 207Q00000X , with the licence number:  46913 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 88557863 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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