Provider Demographics
NPI:1790769388
Name:CHANDRAMOULI, RANJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJANA
Middle Name:
Last Name:CHANDRAMOULI
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 1:2520 K AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5342
Mailing Address - Country:US
Mailing Address - Phone:469-488-3900
Mailing Address - Fax:469-488-3901
Practice Address - Street 1:2520 K AVE STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5342
Practice Address - Country:US
Practice Address - Phone:469-488-3900
Practice Address - Fax:469-488-3901
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342293311Medicaid
MDI08932Medicare UPIN