Healthcare Provider Details

I. General information

NPI: 1730140013
Provider Name (Legal Business Name): PUTTAGUNTA RANGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 SOUTHLAND RD
NEW BREMEN OH
45869
US

IV. Provider business mailing address

PO BOX 98
NEW BREMEN OH
45869-0098
US

V. Phone/Fax

Practice location:
  • Phone: 419-629-3663
  • Fax: 419-629-2783
Mailing address:
  • Phone: 419-629-3663
  • Fax: 419-629-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35045040
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: