Provider Demographics
NPI:1205830221
Name:ROY, RANJAN SHANTI (PHO, MD)
Entity Type:Individual
Prefix:MR
First Name:RANJAN
Middle Name:SHANTI
Last Name:ROY
Suffix:
Gender:M
Credentials:PHO, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W STE 104
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1385
Practice Address - Country:US
Practice Address - Phone:704-645-0901
Practice Address - Fax:704-645-0907
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500208207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973488Medicaid
NCF98672Medicare UPIN
NC8973488Medicaid