Provider Demographics
NPI:1699776559
Name:RAHANGDALE, SANDEEP (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:RAHANGDALE
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 1:3827 E MILLERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1061
Mailing Address - Country:US
Mailing Address - Phone:850-766-8496
Mailing Address - Fax:850-210-0315
Practice Address - Street 1:3606 MACLAY BLVD S STE 104
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1277
Practice Address - Country:US
Practice Address - Phone:850-210-0593
Practice Address - Fax:850-210-0315
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSG058336OtherVISTA
FL42844OtherBCBS OF FLORIDA
FL00000OtherSOUTH CARE
FL00000OtherMULTIPLAN
FL00000OtherUNITED HEALTH CARE
FL00000OtherHUMANA/CHOICE CARE
FL00000Medicaid
FL00000OtherBEECH ST/CAPP CARE
FL00000Medicaid
FL00000OtherUNITED HEALTH CARE