Healthcare Provider Details

I. General information

NPI: 1942569082
Provider Name (Legal Business Name): RANJIT MANDHARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 GENESEE ST
UTICA NY
13501-5999
US

IV. Provider business mailing address

2209 GENESEE STREET BUSINESS OFFICE ROOM 310
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-801-8263
  • Fax: 315-801-4988
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number280534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: