Individual
PRAVEEN GANTI RANGANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-9729
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
282200
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2015
Last updated
10/22/2023
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