Provider Demographics
NPI:1164771515
Name:RANGA BALASEKARAN MD PA
Entity Type:Organization
Organization Name:RANGA BALASEKARAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-278-9453
Mailing Address - Street 1:8201 YUKON AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9056
Mailing Address - Country:US
Mailing Address - Phone:903-792-4146
Mailing Address - Fax:903-792-0586
Practice Address - Street 1:1002 TEXAS BLVD STE 401
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5113
Practice Address - Country:US
Practice Address - Phone:903-792-4146
Practice Address - Fax:903-792-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5792207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH12387Medicare UPIN