1912979436 NPI number — GUBBI NAGARAI RANGANATH MD

Table of content: GUBBI NAGARAI RANGANATH MD (NPI 1912979436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912979436 NPI number — GUBBI NAGARAI RANGANATH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANGANATH
Provider First Name:
GUBBI
Provider Middle Name:
NAGARAI
Provider Name Prefix Text:
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:
1912979436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 783311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-884-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 S SILLYMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESSONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2006

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:  MD041078L , 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: 01144501 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020301000 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011884760001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110031033 . This is a "RAILROAD MEDICARE PBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0473231 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 38784 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000583463 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 116993900 . This is a "FEDERAL EMPLOYEES COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01144501 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0998130 . This is a "KEYSTONE SPECIALIST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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