Provider Demographics
NPI:1477646594
Name:VELLANKI, R. RAO (MD)
Entity Type:Individual
Prefix:
First Name:R. RAO
Middle Name:
Last Name:VELLANKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMAMOHAN
Other - Middle Name:RAO
Other - Last Name:VELLANKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1305 EASTWOOD CIR SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4380
Mailing Address - Country:US
Mailing Address - Phone:330-494-5505
Mailing Address - Fax:
Practice Address - Street 1:1305 EASTWOOD CIR SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4380
Practice Address - Country:US
Practice Address - Phone:330-494-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 035147207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0527380Medicaid
OH0527380Medicaid
F 25389Medicare UPIN