Provider Demographics
NPI:1104815299
Name:RANGRAJ, MADHU SUDAN (MD FACS)
Entity type:Individual
Prefix:
First Name:MADHU
Middle Name:SUDAN
Last Name:RANGRAJ
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-632-9650
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0807HOtherEMPIRE BCBS
WS860OtherOXFORD
NY00531131Medicaid
OD2739OtherHEALTHNET
B13273Medicare UPIN
337092Medicare ID - Type Unspecified