Provider Demographics
NPI:1801851217
Name:POTU, RANGANATHA PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:RANGANATHA
Middle Name:PRASAD
Last Name:POTU
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 1:6122 W CORPORATE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8722
Mailing Address - Country:US
Mailing Address - Phone:352-228-8429
Mailing Address - Fax:352-794-6326
Practice Address - Street 1:6122 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8722
Practice Address - Country:US
Practice Address - Phone:352-228-8429
Practice Address - Fax:352-794-6326
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36819207RC0000X
FLME0036819207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060000091OtherRAIL ROAD MEDICARE
FL09052OtherBLUE CROSS/BLUE SHIELD
FL001262401Medicaid
FL095765662OtherTRI CARE FOR LIFE
FLD84994Medicare UPIN
FL09052YMedicare PIN