Provider Demographics
NPI:1447227582
Name:SUDHEENDRA, RAO (MD)
Entity Type:Individual
Prefix:
First Name:RAO
Middle Name:
Last Name:SUDHEENDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAO
Other - Middle Name:
Other - Last Name:SUDHEENDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4100 YOUNGSTOWN RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3346
Mailing Address - Country:US
Mailing Address - Phone:330-306-0300
Mailing Address - Fax:330-306-0700
Practice Address - Street 1:4100 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3346
Practice Address - Country:US
Practice Address - Phone:330-306-0300
Practice Address - Fax:330-306-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350392332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318374Medicaid
OH0318374Medicaid