Provider Demographics
NPI:1740206812
Name:FERNANDO, RANPALI (MD)
Entity Type:Individual
Prefix:
First Name:RANPALI
Middle Name:
Last Name:FERNANDO
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 1:1790 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1042
Mailing Address - Country:US
Mailing Address - Phone:516-361-7151
Mailing Address - Fax:516-683-8031
Practice Address - Street 1:1790 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1042
Practice Address - Country:US
Practice Address - Phone:516-361-7151
Practice Address - Fax:516-683-8031
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126478208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00932307Medicaid
NY91A90ETO41Medicare PIN
NY00932307Medicaid
NY05705Medicare ID - Type Unspecified