Provider Demographics
NPI:1356503619
Name:RAO, VIJAYALAKSHMI KASUNGANTI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYALAKSHMI
Middle Name:KASUNGANTI
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1502 AUTUMN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3815
Mailing Address - Country:US
Mailing Address - Phone:502-742-3878
Mailing Address - Fax:
Practice Address - Street 1:3000 ASH AVE
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056
Practice Address - Country:US
Practice Address - Phone:502-241-8454
Practice Address - Fax:502-241-3067
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38016208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice