Provider Demographics
NPI:1518965813
Name:BALASEKARAN, RANGA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANGA
Middle Name:
Last Name:BALASEKARAN
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 1:601 W MAPLE AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-757-8150
Mailing Address - Fax:479-757-8155
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-757-8150
Practice Address - Fax:479-757-8155
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5792207RG0100X
ARE7733207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8308K0Medicare PIN
TXH12387Medicare UPIN
ARH12387Medicare UPIN
AR8308K0Medicare PIN