Provider Demographics
NPI:1730140013
Name:RANGA, PUTTAGUNTA (MD)
Entity Type:Individual
Prefix:
First Name:PUTTAGUNTA
Middle Name:
Last Name:RANGA
Suffix:
Gender:M
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 98
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-0098
Mailing Address - Country:US
Mailing Address - Phone:419-629-3663
Mailing Address - Fax:419-629-2783
Practice Address - Street 1:3920 SOUTHLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869
Practice Address - Country:US
Practice Address - Phone:419-629-3663
Practice Address - Fax:419-629-2783
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH791063817AOtherRR MEDICARE
OH000000130573OtherANTHEM
OH0431269Medicaid
OH0431269Medicaid
OH791063817AOtherRR MEDICARE