Provider Demographics
NPI:1285630004
Name:RURANGIRWA, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:RURANGIRWA
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 1:1119 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7532
Mailing Address - Country:US
Mailing Address - Phone:956-548-0900
Mailing Address - Fax:956-548-0776
Practice Address - Street 1:1119 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7532
Practice Address - Country:US
Practice Address - Phone:956-548-0900
Practice Address - Fax:956-548-0776
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3446174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285630004OtherAETNA
1285630004OtherVALLEY HEALTH PLANS
1285630004OtherTML
1285630004OtherCIGNA
1285630004OtherAMERICAN ADMINISTRATIVE GROUP
TX1285630004Medicaid
1285630004OtherUNITED HEALTHCARE
1285630004OtherTML
1285630004Medicare PIN
1285630004Medicare NSC