Provider Demographics
NPI:1649241829
Name:RANGARAJ, KUMUD SHARMA (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMUD
Middle Name:SHARMA
Last Name:RANGARAJ
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 1:1505 NORTHSIDE BLVD STE 4600
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7658
Mailing Address - Country:US
Mailing Address - Phone:770-205-5292
Mailing Address - Fax:770-205-5291
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 4600
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7658
Practice Address - Country:US
Practice Address - Phone:770-205-5292
Practice Address - Fax:770-205-5291
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS082798207RH0003X
GA059007207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B56404008OtherBCR
MI4790701Medicaid
MI0B56404-008Medicare ID - Type Unspecified
MI4790701Medicaid