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General NPI Number Information
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NPI Number | 1518171339
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE & GERIATRICS, P.C.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 3369 NE STEPHENS ST. STE. 100
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City | ROSEBURG
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State | OR
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Zip | 97470
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Country | US
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Telephone | 541-677-8900
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Fax | 541-677-8900
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Provider Business Mailing Address
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Address Line | 3369 NE STEPHENS ST. STE 100
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City | ROSEBURG
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State | OR
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Zip | 97470
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Country | US
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Telephone | 541-677-8900
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Fax | 541-677-8903
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Authorized Official
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Title or Position | MD
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Name | RANGANATHAN RAJENDRAN
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Credential | MD
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Telephone | 541-677-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24877
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License Number State | OR
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