Provider Demographics
NPI:1588690879
Name:RANGARAJ, VENKATAPPA (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATAPPA
Middle Name:
Last Name:RANGARAJ
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 1:4415 FRONT NINE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6239
Mailing Address - Country:US
Mailing Address - Phone:678-456-8463
Mailing Address - Fax:770-406-1058
Practice Address - Street 1:4415 FRONT NINE DR STE 600
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6239
Practice Address - Country:US
Practice Address - Phone:770-744-7688
Practice Address - Fax:770-406-1058
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340376313IMedicaid
GA003132617AMedicaid
GA003132617AMedicaid
202I114238Medicare UPIN
GA202I112350Medicare PIN
GA340376313IMedicaid