1679574644 NPI number — MOHAMMAD JAVED RANA M.D.

Table of content: MOHAMMAD JAVED RANA M.D. (NPI 1679574644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679574644 NPI number — MOHAMMAD JAVED RANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANA
Provider First Name:
MOHAMMAD
Provider Middle Name:
JAVED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RANA
Provider Other First Name:
M. JAVED
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679574644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2003 LEATHERWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24605-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-322-0000
Provider Business Mailing Address Fax Number:
276-322-0003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 LEATHERWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24605-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-322-0000
Provider Business Practice Location Address Fax Number:
276-322-0003
Provider Enumeration Date:
08/02/2005

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: 207RC0000X , with the licence number:  18953 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010114918 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18953 . This is a "STATE LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00140857 . This is a "TRAVELERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542154731 . This is a "TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 550771289 . This is a "TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1518077890 . This is a "CORPORATION NPI#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0080080000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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