Basic Information
Provider Information
NPI: 1003012451
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MITRA
FirstName: RANJANA
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 KEMPSVILLE RD
Address2:  
City: NORFOLK
State: VA
PostalCode: 235023920
CountryCode: US
TelephoneNumber: 7572615283
FaxNumber: 7572615849
Practice Location
Address1: 850 KEMPSVILLE RD
Address2:  
City: NORFOLK
State: VA
PostalCode: 235023920
CountryCode: US
TelephoneNumber: 7572615283
FaxNumber: 7572615849
Other Information
ProviderEnumerationDate: 06/22/2007
LastUpdateDate: 10/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101242262VAY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X2007-00907NCN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X0101242262VAN Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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