Provider Demographics
NPI:1477525103
Name:RAO, BABU V (MD)
Entity Type:Individual
Prefix:
First Name:BABU
Middle Name:V
Last Name:RAO
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 1:241 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2179
Mailing Address - Country:US
Mailing Address - Phone:731-660-3500
Mailing Address - Fax:731-660-3507
Practice Address - Street 1:241 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2179
Practice Address - Country:US
Practice Address - Phone:731-660-3500
Practice Address - Fax:731-660-3507
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021480207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64712649Medicaid
TNQ009489Medicaid
TN3060069Medicaid
P00670752OtherRR MEDICARE
KY64712649Medicaid
TNQ009489Medicaid
TN3060069Medicare ID - Type Unspecified