Provider Demographics
NPI:1184805210
Name:RANJITHAN MEDICAL ASSOCIATION
Entity type:Organization
Organization Name:RANJITHAN MEDICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANJITHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-9393
Mailing Address - Street 1:517 OLDTOWN RD REAR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3670
Mailing Address - Country:US
Mailing Address - Phone:301-777-9393
Mailing Address - Fax:301-777-9066
Practice Address - Street 1:517 OLDTOWN RD REAR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3670
Practice Address - Country:US
Practice Address - Phone:301-777-9393
Practice Address - Fax:301-777-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019318207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCB3216OtherRR MEDICARE
MD220981100Medicaid
MDS025Medicare PIN