Provider Demographics
NPI:1912101585
Name:KANDALA, RANGANATH (MD)
Entity type:Individual
Prefix:DR
First Name:RANGANATH
Middle Name:
Last Name:KANDALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 TOWN CENTER BLVD S
Mailing Address - Street 2:STE B
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1001
Mailing Address - Country:US
Mailing Address - Phone:832-771-2601
Mailing Address - Fax:281-213-0169
Practice Address - Street 1:3519 TOWN CENTER BLVD S
Practice Address - Street 2:STE B
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1001
Practice Address - Country:US
Practice Address - Phone:281-240-0311
Practice Address - Fax:281-240-0313
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8070207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3899556410OtherMYUTMB 3899556410-COMMERCIAL NUMBER