Healthcare Provider Details

I. General information

NPI: 1265432488
Provider Name (Legal Business Name): NARAYANASWAMI RANGASWAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 BREEDLOVE ST
MEMPHIS TN
38107-2805
US

IV. Provider business mailing address

877 JEFFERSON AVE 5TH FLOOR ADAMS PAVILION
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-5400
  • Fax: 901-526-1208
Mailing address:
  • Phone: 901-515-4529
  • Fax: 901-515-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number11404
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11404
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: