Provider Demographics
NPI:1275648131
Name:RAO, ANNAPURNA CHAVALI (MD)
Entity Type:Individual
Prefix:
First Name:ANNAPURNA
Middle Name:CHAVALI
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 VALE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-4074
Mailing Address - Country:US
Mailing Address - Phone:219-614-4893
Mailing Address - Fax:703-255-4984
Practice Address - Street 1:9900 VALE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-4074
Practice Address - Country:US
Practice Address - Phone:219-614-4893
Practice Address - Fax:703-255-4984
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003003982085R0202X
VA30374208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140G3OtherBCBS
NC5902110Medicaid
NCP00252933Medicare PIN
NC140G3OtherBCBS
NCP00462673Medicare PIN
NC2044552Medicare PIN
NC2044552AMedicare PIN