Basic Information
| Provider Information | |||||||||
| NPI: | 1528329778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAKESH RANJAN MD & ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHARAK CENTER FOR HEALTH & WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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: | 06/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | RANJAN | ||||||||
| AuthorizedOfficialFirstName: | RAKESH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3307252305 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 2911648 | 05 | OH | MEDICAID |