Provider Demographics
NPI:1194714642
Name:CHANDRAN, RANGRAM (MD)
Entity type:Individual
Prefix:
First Name:RANGRAM
Middle Name:
Last Name:CHANDRAN
Suffix:
Gender:M
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:PO BOX 576067
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6067
Mailing Address - Country:US
Mailing Address - Phone:209-572-2020
Mailing Address - Fax:209-572-4000
Practice Address - Street 1:304 BANNER CT
Practice Address - Street 2:SUITE 1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9194
Practice Address - Country:US
Practice Address - Phone:209-572-2020
Practice Address - Fax:209-572-4000
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81157207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA134886OtherMEDICARE PTAN
CA00A811570Medicaid
00A811570Medicare ID - Type Unspecified
H72576Medicare UPIN