Provider Demographics
NPI:1588615520
Name:RANGANATHAN, SAMANAICKER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANAICKER
Middle Name:
Last Name:RANGANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:RANGANATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1250 W STATE ROAD 434
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4969
Mailing Address - Country:US
Mailing Address - Phone:407-260-8227
Mailing Address - Fax:407-260-2884
Practice Address - Street 1:1250 W STATE ROAD 434
Practice Address - Street 2:SUITE 1004
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4969
Practice Address - Country:US
Practice Address - Phone:407-260-8227
Practice Address - Fax:407-260-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067397800Medicaid
FL067397800Medicaid
FLD57073Medicare UPIN
FL110008085Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE