Provider Demographics
NPI:1912979436
Name:RANGANATH, GUBBI NAGARAI (MD)
Entity type:Individual
Prefix:
First Name:GUBBI
Middle Name:NAGARAI
Last Name:RANGANATH
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:35 S SILLYMAN ST
Practice Address - Street 2:
Practice Address - City:CRESSONA
Practice Address - State:PA
Practice Address - Zip Code:17929
Practice Address - Country:US
Practice Address - Phone:570-385-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041078L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01144501OtherCAPITAL BLUE CROSS
PA020301000OtherFEDERAL BLACK LUNG
PA0011884760001Medicaid
PA110031033OtherRAILROAD MEDICARE PBA
PA0473231OtherUS HEALTHCARE
PA38784OtherGEISINGER HEALTH PLAN
PA0000583463OtherBLUE SHIELD
PA116993900OtherFEDERAL EMPLOYEES COMP
PA01144501OtherKEYSTONE
PA0998130OtherKEYSTONE SPECIALIST
PA0473231OtherUS HEALTHCARE
PA110031033OtherRAILROAD MEDICARE PBA