Provider Demographics
NPI:1306208467
Name:BANSAL, RANI
Entity Type:Individual
Prefix:
First Name:RANI
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MACON POND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6319
Mailing Address - Country:US
Mailing Address - Phone:919-781-7070
Mailing Address - Fax:
Practice Address - Street 1:4101 MACON POND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6319
Practice Address - Country:US
Practice Address - Phone:919-781-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267516207R00000X
390200000X
NC2022-00581207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program