Healthcare Provider Details

I. General information

NPI: 1205843810
Provider Name (Legal Business Name): RANGAPPA RAJENDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44055 RIVERSIDE PKWY STE 224
LANSDOWNE VA
20176-5177
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-3110
  • Fax: 703-858-3111
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101042613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: