Provider Demographics
NPI:1043355019
Name:MADHAVAN, RANGANATHAN GURU (MD)
Entity Type:Individual
Prefix:DR
First Name:RANGANATHAN
Middle Name:GURU
Last Name:MADHAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7805 PARK RIVER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5816
Mailing Address - Country:US
Mailing Address - Phone:541-291-9080
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-7506
Practice Address - Fax:916-734-4810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27726207R00000X, 208M00000X
TXP0757207R00000X
CAA118613208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine