Provider Demographics
NPI:1679643225
Name:BOPPANA, RANU (MD)
Entity Type:Individual
Prefix:DR
First Name:RANU
Middle Name:
Last Name:BOPPANA
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 1:19 W 34TH ST
Mailing Address - Street 2:PH SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:212-947-7111
Mailing Address - Fax:212-208-2498
Practice Address - Street 1:115 E 87TH ST
Practice Address - Street 2:#22D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1136
Practice Address - Country:US
Practice Address - Phone:917-496-1311
Practice Address - Fax:212-208-2498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1913632084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry