Healthcare Provider Details

I. General information

NPI: 1528519253
Provider Name (Legal Business Name): RANJAN MAHAJAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLEARWATER LARGO RD N
LARGO FL
33770-2388
US

IV. Provider business mailing address

150 CLEARWATER LARGO RD N
LARGO FL
33770-2388
US

V. Phone/Fax

Practice location:
  • Phone: 727-518-0822
  • Fax: 727-518-6511
Mailing address:
  • Phone: 727-518-0822
  • Fax: 727-518-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9337786
License Number StateFL

VIII. Authorized Official

Name: VICKY KIGER
Title or Position: MANAGER
Credential:
Phone: 727-518-0822