Provider Demographics
NPI:1396063616
Name:DR RAJESH S RANA MD PA
Entity type:Organization
Organization Name:DR RAJESH S RANA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-681-6401
Mailing Address - Street 1:18601 LBJ FWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5600
Mailing Address - Country:US
Mailing Address - Phone:972-681-6401
Mailing Address - Fax:972-681-2515
Practice Address - Street 1:18601 LBJ FWY
Practice Address - Street 2:SUITE 320
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5600
Practice Address - Country:US
Practice Address - Phone:972-681-6401
Practice Address - Fax:972-681-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216150701Medicaid
DS3727OtherMEDICARE RAILROAD CARRIER
TXB103408Medicare PIN
F60391Medicare UPIN