Provider Demographics
NPI:1952491250
Name:RANGWALLA-MALICKEL, INCIYA (DO)
Entity Type:Individual
Prefix:
First Name:INCIYA
Middle Name:
Last Name:RANGWALLA-MALICKEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLAZA
Practice Address - Street 2:THE COOPER HOSPITALIST TEAM
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-3150
Practice Address - Fax:856-968-8418
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB077643207R00000X
NJ25MB07764300208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3627197OtherAETNA
2371176000OtherAMERIHEALTH, KEYSTONE, IBC
2457199OtherUNITED HEALTHCARE
010006648OtherAMERICHOICE
3K6195OtherHEALTHNET
42589OtherUNIVERSITY HEALTHPLAN
P3408632OtherOXFORD
42589OtherUNIVERSITY HEALTHPLAN
P3408632OtherOXFORD