1255819470 NPI number — SUMANYA VENKAT RAO DDS PC

Table of content: (NPI 1255819470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255819470 NPI number — SUMANYA VENKAT RAO DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMANYA VENKAT RAO DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1255819470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3635 OLD COURT RD STE 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-898-6788
Provider Business Mailing Address Fax Number:
443-213-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3635 OLD COURT RD STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-540-6007
Provider Business Practice Location Address Fax Number:
443-609-4713
Provider Enumeration Date:
07/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VENKAT RAO
Authorized Official First Name:
SUMANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL DENTIST
Authorized Official Telephone Number:
443-898-6788

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  15681 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 089290400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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