Provider Demographics
NPI:1316003304
Name:RANCHOD, TUSHAR (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:
Last Name:RANCHOD
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 1:365 LENNON LN STE 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-522-8858
Mailing Address - Fax:925-522-8851
Practice Address - Street 1:365 LENNON LN STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5915
Practice Address - Country:US
Practice Address - Phone:925-943-6800
Practice Address - Fax:925-943-6880
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113274207W00000X
CAA113274207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
94-3064464OtherGROUP TAX ID
CAGR0030671Medicaid
ZZZ19344ZMedicare PIN
0Q26082043Medicare PIN
ZZZ19342ZMedicare PIN
94-3064464OtherGROUP TAX ID
CAGR0030671Medicaid
CAEE426TMedicare PIN
ZZZ36260ZMedicare PIN
ZZZ19343ZMedicare PIN
CAAQ573AMedicare PIN