Provider Demographics
NPI:1043702459
Name:RANADE, TEJAS SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:SANJAY
Last Name:RANADE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:652 S MEDICAL CENTER DR STE 320
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7266
Practice Address - Country:US
Practice Address - Phone:435-251-3950
Practice Address - Fax:435-251-3951
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR00682852084N0400X
IL0361634892084N0400X
NC2023-030892084N0400X
PAMD4814272084N0400X
UT13696619-12352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A