Provider Demographics
NPI:1225089550
Name:RANGNEKAR, NITIN J (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:J
Last Name:RANGNEKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 PARKSIDE DRIVE, G-9
Mailing Address - Street 2:TENNOVA SURGICAL ASSOCIATES
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-218-6085
Mailing Address - Fax:865-218-6086
Practice Address - Street 1:10810 PARKSIDE DRIVE, G-9
Practice Address - Street 2:TENNOVA SURGICAL ASSOCIATES
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-218-6085
Practice Address - Fax:865-218-6086
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42733208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001201Medicaid
MO20044340OtherRR MEDICARE
TN3001201Medicaid
TN30012012Medicare PIN
MO095011108Medicare PIN
TN3001201Medicaid
H06663Medicare UPIN