Provider Demographics
NPI:1659327419
Name:WADHWA, RANJU B (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJU
Middle Name:B
Last Name:WADHWA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1701 SE HILLMOOR DR
Mailing Address - Street 2:D-16
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-800-7758
Mailing Address - Fax:772-800-7867
Practice Address - Street 1:1701 SE HILLMOOR DR
Practice Address - Street 2:D-16
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-800-7758
Practice Address - Fax:772-800-7867
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 63650207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF83675Medicare UPIN
FL18902TMedicare PIN