Provider Demographics
NPI:1902885411
Name:ACHREJA, RANVIR SINGH (MD)
Entity Type:Individual
Prefix:MR
First Name:RANVIR
Middle Name:SINGH
Last Name:ACHREJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27341-8613
Mailing Address - Country:US
Mailing Address - Phone:336-873-7248
Mailing Address - Fax:336-873-7238
Practice Address - Street 1:614 N BROAD ST
Practice Address - Street 2:
Practice Address - City:SEAGROVE
Practice Address - State:NC
Practice Address - Zip Code:27341-8613
Practice Address - Country:US
Practice Address - Phone:336-873-7248
Practice Address - Fax:336-873-7238
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001214701208600000X
ND11137208600000X
NC27560208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910039Medicaid
NC8910141Medicaid
NC8910141Medicaid
NC8910039Medicaid
203032Medicare ID - Type Unspecified