Provider Demographics
NPI:1396990214
Name:RANGARAJ, PADMAJA (MD)
Entity type:Individual
Prefix:MRS
First Name:PADMAJA
Middle Name:
Last Name:RANGARAJ
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 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:609-653-3500
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:9507 CASTLEFORD PT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5766
Practice Address - Country:US
Practice Address - Phone:609-653-3500
Practice Address - Fax:609-926-4311
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114949208M00000X
NJ25MA08665700207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00728100OtherRR MEDICARE
NJ47983-CAPEOtherUHP-NON PAR
NJ0194565Medicaid
NJ150222ZDQ0Medicare PIN