Provider Demographics
NPI:1417938598
Name:RAO, SRINIVAS P
Entity Type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:P
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 1:11221 KATY FWY STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2105
Mailing Address - Country:US
Mailing Address - Phone:281-888-1464
Mailing Address - Fax:
Practice Address - Street 1:11221 KATY FWY STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2105
Practice Address - Country:US
Practice Address - Phone:281-888-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH76442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139311802Medicaid
TX88R304Medicare PIN
TX139311802Medicaid