Provider Demographics
NPI:1164433066
Name:RAO, SHANTHA V (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTHA
Middle Name:V
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2150 APPIAN WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2520
Mailing Address - Country:US
Mailing Address - Phone:510-724-7247
Mailing Address - Fax:510-724-7160
Practice Address - Street 1:545 PIERCE ST APT 3107
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1072
Practice Address - Country:US
Practice Address - Phone:510-724-7247
Practice Address - Fax:510-724-7160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA42839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA042839OtherLICENSE #
CA207R00000XOtherTAXONOMY CODE
CA207R00000XOtherTAXONOMY CODE
CAE34362Medicare UPIN
CABRO597546OtherDEA