Provider Demographics
NPI:1861581266
Name:MAHAJAN, RANJAN (MD,FACP)
Entity type:Individual
Prefix:
First Name:RANJAN
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:STE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:727-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:STE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:727-518-6511
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0069005207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378547500Medicaid
FL27643ZMedicare ID - Type Unspecified
FLG12873Medicare UPIN