Basic Information
Provider Information | |||||||||
NPI: | 1083975239 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RAKESH RANJAN, MD & ASSOCIATES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CHARAK CENTER FOR HEALTH & WELLNESS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 801 E WASHINGTON ST | ||||||||
Address2: | SUITE 150 | ||||||||
City: | MEDINA | ||||||||
State: | OH | ||||||||
PostalCode: | 442563335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3307221069 | ||||||||
FaxNumber: | 3307649712 | ||||||||
Practice Location | |||||||||
Address1: | 801 E WASHINGTON ST | ||||||||
Address2: | SUITE 150 | ||||||||
City: | MEDINA | ||||||||
State: | OH | ||||||||
PostalCode: | 442563335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3307221069 | ||||||||
FaxNumber: | 3307649712 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2012 | ||||||||
LastUpdateDate: | 06/08/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RANJAN | ||||||||
AuthorizedOfficialFirstName: | RAKESH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3307252305 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103TC1900X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling | 101YM0800X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 2910774 | 05 | OH |   | MEDICAID |