Provider Demographics
NPI:1790836252
Name:NAGARAKANTI, RANGADHAM (MD)
Entity Type:Individual
Prefix:
First Name:RANGADHAM
Middle Name:
Last Name:NAGARAKANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:NAGARAKANTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:ATTN: PAYER CREDENTIALING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:269 S CANDY LN
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4158
Practice Address - Country:US
Practice Address - Phone:928-634-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08495300207RC0000X
AZ67092207RC0001X
LAMD202854207RC0000X
KY48585207RC0000X, 207RC0001X, 207R00000X
TXR3562207RC0001X
PAMD424922207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ153142Medicaid
IN201338570Medicaid
NJ0301825Medicaid
LA1883182Medicaid
IN201338570Medicaid