Provider Demographics
NPI:1073946612
Name:RANGAIAH, GOVINDAPPA
Entity Type:Individual
Prefix:DR
First Name:GOVINDAPPA
Middle Name:
Last Name:RANGAIAH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GOVINDAPPA
Other - Middle Name:
Other - Last Name:RANGAIAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14 BLACKHAWK RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7708
Mailing Address - Country:US
Mailing Address - Phone:914-472-2718
Mailing Address - Fax:
Practice Address - Street 1:14 BLACKHAWK RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-7708
Practice Address - Country:US
Practice Address - Phone:646-853-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112231207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery