Provider Demographics
NPI:1114140324
Name:RANJAN MAHAJAN, MD PLC
Entity Type:Organization
Organization Name:RANJAN MAHAJAN, MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-518-0822
Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:727-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:SUITE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:727-518-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069005173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3622Medicare UPIN
FL27643ZMedicare ID - Type UnspecifiedMEDICARE