Provider Demographics
NPI:1528519253
Name:RANJAN MAHAJAN MD
Entity type:Organization
Organization Name:RANJAN MAHAJAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-518-0822
Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:727-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:727-518-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9337786363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9337786OtherLICENCE ARNP