Provider Demographics
NPI:1780683961
Name:RANA, ANJUM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJUM
Middle Name:
Last Name:RANA
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 5049
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-5049
Mailing Address - Country:US
Mailing Address - Phone:304-425-0120
Mailing Address - Fax:304-431-3075
Practice Address - Street 1:144 UNDERCLIFF TER
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2174
Practice Address - Country:US
Practice Address - Phone:304-425-0120
Practice Address - Fax:304-431-3075
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17589174400000X, 207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0109934000Medicaid
WVG20154Medicare UPIN
WV0795361Medicare PIN