Provider Demographics
NPI:1598963746
Name:RANGASAMY, PRIYA (MD,)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:RANGASAMY
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 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:909 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3916
Practice Address - Country:US
Practice Address - Phone:817-877-0888
Practice Address - Fax:817-877-5039
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5962207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DK755OtherBCBSTX
TX287626002Medicaid
TXTXB162205Medicare PIN