Provider Demographics
NPI:1093935348
Name:RENGARAJU, BRINDA (MD)
Entity Type:Individual
Prefix:
First Name:BRINDA
Middle Name:
Last Name:RENGARAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRINDA
Other - Middle Name:
Other - Last Name:VANCHALINGAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-687-0156
Mailing Address - Fax:978-681-7573
Practice Address - Street 1:70 EAST ST.
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-687-0156
Practice Address - Fax:978-681-7573
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001446207R00000X
MA233956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH56204Medicare ID - Type Unspecified
GUI01213Medicare UPIN