Provider Demographics
NPI:1447211149
Name:RANADIVE, VIRENDRA V (MD)
Entity Type:Individual
Prefix:MR
First Name:VIRENDRA
Middle Name:V
Last Name:RANADIVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 SUMNER RD FL 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4758
Mailing Address - Country:US
Mailing Address - Phone:770-716-1562
Mailing Address - Fax:770-716-0145
Practice Address - Street 1:115 SUMNER RD FL 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4758
Practice Address - Country:US
Practice Address - Phone:770-716-1562
Practice Address - Fax:770-716-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0475102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44492Medicare UPIN
13BDDKYMedicare ID - Type Unspecified