Healthcare Provider Details

I. General information

NPI: 1245428960
Provider Name (Legal Business Name): RAGU P SANJEEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAGURANJAN SANJEEVI PANDURANGAN

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DRIVE SUITE 2100
NEWARK DE
19713-2049
US

IV. Provider business mailing address

10313 GEORGIA AVE STE 207
SILVER SPRING MD
20902-5006
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-623-0554
Mailing address:
  • Phone: 301-681-7010
  • Fax: 301-593-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0084010
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLICENSE # C1-0009185
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: