1144268095 NPI number — RAMA K RAO MD

Table of content: RAMA K RAO MD (NPI 1144268095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144268095 NPI number — RAMA K RAO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAO
Provider First Name:
RAMA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144268095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
759 OLD NORCROSS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-300-2379
Provider Business Mailing Address Fax Number:
404-300-2379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 JOHNSON FERRY RD STE 910
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-303-3750
Provider Business Practice Location Address Fax Number:
404-252-4755
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD424592 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 068605 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003133951C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003133951D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003133951B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101394136 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 711589 . This is a "HIGHMARK BLUE SHIELD-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 003133951A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414474 . This is a "UPMC-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 414831201 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1583684 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 917882 . This is a "CAREFIRST MD BCBS -WMG" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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