MEDICARE: MR. VIRENDRA V RANADIVE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	047510	GA

General Provider Information

NPI Number	:	1447211149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIRENDRA V RANADIVE MD

Provider Business Mailing Address
First Line	:	115 SUMNER RD FL 2
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4758
Country	:	US
Telephone Number	:	770-716-1562
Fax Number	:	770-716-0145

Provider Business Practice Location Address
First Line	:	115 SUMNER RD FL 2
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4758
Country	:	US
Telephone Number	:	770-716-1562
Fax Number	:	770-716-0145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/28/2018

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