Provider Demographics
NPI:1992773212
Name:RANGANATHAN, VADAK H (MD)
Entity type:Individual
Prefix:
First Name:VADAK
Middle Name:H
Last Name:RANGANATHAN
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 1:3152 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-629-0940
Mailing Address - Fax:937-629-0942
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 350
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2885
Practice Address - Country:US
Practice Address - Phone:419-998-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74925174400000X, 2084N0400X
IN01038317A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH74925OtherSTATE LICENSE
OH2084195Medicaid
OH2084195Medicaid
OH74925OtherSTATE LICENSE