=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396990214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PADMAJA RANGARAJ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2008
-----------------------------------------------------
Last Update Date | 12/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9507 CASTLEFORD PT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-5766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-653-3500
-----------------------------------------------------
Fax | 609-926-4311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1507 S HIAWASSEE RD STE 107
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-653-3500
-----------------------------------------------------
Fax | 609-926-4311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | ME114949
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------