Provider Demographics
NPI:1518173608
Name:RANPURIA, REENA K (MD)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:K
Last Name:RANPURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 GREENWAY CENTER DR
Mailing Address - Street 2:STE 930
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3587
Mailing Address - Country:US
Mailing Address - Phone:303-626-6348
Mailing Address - Fax:866-639-1174
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-929-4425
Practice Address - Fax:408-929-4487
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT179524207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04539ZOtherMEDICARE GROUP
CA00A995868OtherMEDICARE PTAN
CA1316099658OtherGROUP NPI
CA1518173608Medicaid
CAZZZ27071ZOtherMEDICARE GROUP
CA1316099658OtherGROUP NPI