Provider Demographics
NPI:1073063913
Name:THANDASSERY, RAGESH BABU (MD)
Entity Type:Individual
Prefix:
First Name:RAGESH
Middle Name:BABU
Last Name:THANDASSERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95STREET
Mailing Address - Street 2:332 EAST APARTMENT 1
Mailing Address - City:NEWYORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5770
Mailing Address - Country:US
Mailing Address - Phone:917-378-9341
Mailing Address - Fax:
Practice Address - Street 1:95STREET
Practice Address - Street 2:332 EAST APARTMENT 1
Practice Address - City:NEWYORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5770
Practice Address - Country:US
Practice Address - Phone:917-378-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-10677207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program