Healthcare Provider Details

I. General information

NPI: 1902096019
Provider Name (Legal Business Name): ANJALI RANADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MEDICAL CENTER BLVD
CONROE TX
77304-2808
US

IV. Provider business mailing address

508 MEDICAL CENTER BLVD
CONROE TX
77304-2808
US

V. Phone/Fax

Practice location:
  • Phone: 936-523-1720
  • Fax: 936-523-1723
Mailing address:
  • Phone: 936-523-1720
  • Fax: 936-523-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN1094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: