1912101585 NPI number — DR. RANGANATH KANDALA MD

Table of content: DR. RANGANATH KANDALA MD (NPI 1912101585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912101585 NPI number — DR. RANGANATH KANDALA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANDALA
Provider First Name:
RANGANATH
Provider Middle Name:
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:
1912101585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3519 TOWN CENTER BLVD S
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-771-2601
Provider Business Mailing Address Fax Number:
281-213-0169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3519 TOWN CENTER BLVD S
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-240-0311
Provider Business Practice Location Address Fax Number:
281-240-0313
Provider Enumeration Date:
06/14/2007

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: 207RG0300X , with the licence number:  M8070 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3899556410 . This is a "MYUTMB 3899556410-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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