Provider Demographics
NPI:1316963515
Name:RANADE, SMITA S (MD)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:S
Last Name:RANADE
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:7120 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8608
Practice Address - Country:US
Practice Address - Phone:817-347-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81120208000000X
TXM9596208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193507401Medicaid
TX193507402Medicaid
TX193507403Medicaid
TX137345810Medicaid
TX140442852Medicaid
1750369203OtherGROUP NPI
TXB115839OtherMEDICARE PTAN
TX193507402Medicaid