Provider Demographics
NPI:1124320544
Name:PROHEALTH MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PROHEALTH MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:NARSIMHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RANGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-926-6900
Mailing Address - Street 1:408 BETHEL RD
Mailing Address - Street 2:SUITE C 2
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2172
Mailing Address - Country:US
Mailing Address - Phone:609-926-6900
Mailing Address - Fax:609-926-6995
Practice Address - Street 1:408 BETHEL ROAD
Practice Address - Street 2:SUITE C-2
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-6900
Practice Address - Fax:609-926-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07300900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty