Healthcare Provider Details

I. General information

NPI: 1407184757
Provider Name (Legal Business Name): JAI KUMAR RANGAPPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 SHADY GROVE RD STE 120
ROCKVILLE MD
20850-6354
US

IV. Provider business mailing address

15001 SHADY GROVE RD STE 120
ROCKVILLE MD
20850-6354
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-0070
  • Fax:
Mailing address:
  • Phone: 301-251-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD016253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: