Provider Demographics
NPI:1245428960
Name:SANJEEV, RAGU P (MD)
Entity Type:Individual
Prefix:
First Name:RAGU
Middle Name:P
Last Name:SANJEEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAGURANJAN
Other - Middle Name:
Other - Last Name:SANJEEVI PANDURANGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10313 GEORGIA AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-681-7010
Mailing Address - Fax:301-593-8366
Practice Address - Street 1:200 HYGEIA DRIVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2049
Practice Address - Country:US
Practice Address - Phone:302-623-0188
Practice Address - Fax:302-623-0554
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0084010207R00000X
DELICENSE # C1-0009185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA278609OtherAM BD INTERNAL MED EXAM