Provider Demographics
NPI:1669470100
Name:RANICH, TEDINE (MD)
Entity Type:Individual
Prefix:DR
First Name:TEDINE
Middle Name:
Last Name:RANICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:25 CROSSROADS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5421
Practice Address - Country:US
Practice Address - Phone:410-560-2257
Practice Address - Fax:410-560-0218
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD59329207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146800600Medicaid
MD146800600Medicaid
MDE694Medicare ID - Type Unspecified