Provider Demographics
NPI:1528079878
Name:RANGARAJ, RAJESH (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:RANGARAJ
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 1:653 CHEROKEE ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8978
Mailing Address - Country:US
Mailing Address - Phone:770-419-1393
Mailing Address - Fax:770-419-8188
Practice Address - Street 1:653 CHEROKEE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8978
Practice Address - Country:US
Practice Address - Phone:770-419-1393
Practice Address - Fax:770-419-8188
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058314207W00000X, 207W00000X
FLME 94214207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53632Medicare UPIN