Provider Demographics
NPI:1720032386
Name:KANAGALINGAM, SRI RANJINI (MD)
Entity Type:Individual
Prefix:
First Name:SRI RANJINI
Middle Name:
Last Name:KANAGALINGAM
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1994
Practice Address - Fax:740-374-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22889207R00000X
OH35083366208M00000X
OH35.083366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2006663000Medicaid
OH2500430Medicaid
OH000000181954OtherUNISON MEDICAID
OH2500430OtherMOLINA MEDICAID
P00101236OtherRR MEDICARE
000000317242OtherANTHEM BCBS
WV2006663000Medicaid
OHP01483037OtherRAILROAD MEDICARE
P00101236OtherRR MEDICARE
WV2006663000Medicaid
OH310917085081OtherCARESOURCE MEDICAID