Provider Demographics
NPI:1063542660
Name:MUNDHE, RANJANA RAJEEV (MD)
Entity type:Individual
Prefix:
First Name:RANJANA
Middle Name:RAJEEV
Last Name:MUNDHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 ARSENAL ST
Mailing Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-972-5200
Mailing Address - Fax:617-972-5276
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-972-5200
Practice Address - Fax:617-972-5276
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2151332Medicaid
MA2151332Medicaid