Provider Demographics
NPI:1386640670
Name:BHATRAJU, RAO S (MD)
Entity Type:Individual
Prefix:
First Name:RAO
Middle Name:S
Last Name:BHATRAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1698
Mailing Address - Country:US
Mailing Address - Phone:606-432-0168
Mailing Address - Fax:606-432-0639
Practice Address - Street 1:180 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1698
Practice Address - Country:US
Practice Address - Phone:606-432-0168
Practice Address - Fax:606-432-0639
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-08-13
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
KY27559208600000X, 208C00000X, 208G00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000136105OtherBS/BS OF TENN
KYK010543OtherCHAMPUS
KY000000050525OtherBC/BS OF KY
VA098169OtherBS/BS OF VA
WV0125158000Medicaid
KY1409437OtherUMWA FUNDS
KY35000827Medicaid
KY006895400OtherFEDERAL BLACK LUNG
KY64275597Medicaid
WV0125158000Medicaid
KY64275597Medicaid
KY330001253Medicare PIN
KY1509001Medicare PIN