Basic Information
Provider Information
NPI: 1780757740
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RANGANATH
FirstName: SHASHI
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 1221 MERCANTILE LN
Address2: KAISER PERMANENTE LARGO MEDICAL CENTER
City: LARGO
State: MD
PostalCode: 207745374
CountryCode: US
TelephoneNumber: 3016185500
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 02/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD039511DCN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X0101249534VAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X225534MAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XD72174MDY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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