Provider Demographics
NPI:1265454185
Name:RAMACHANDRAN, RANGASAMY
Entity Type:Individual
Prefix:
First Name:RANGASAMY
Middle Name:
Last Name:RAMACHANDRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-222-2202
Mailing Address - Fax:910-222-2201
Practice Address - Street 1:1766 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-222-2202
Practice Address - Fax:910-222-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97007202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126AROtherBCBS
NC89126ARMedicaid
NC89126ARMedicaid
NC126AROtherBCBS
E55760Medicare UPIN