Provider Demographics
NPI:1144736620
Name:RAO, SRIRAM
Entity Type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:11-162 PCAM
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-615-4949
Mailing Address - Fax:215-615-0829
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:11-162 PCAM
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-615-4949
Practice Address - Fax:215-615-0829
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT000798207RA0001X
PAMD469099207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology