Provider Demographics
NPI:1518053909
Name:RAO, SUBBA M (MD)
Entity Type:Individual
Prefix:
First Name:SUBBA
Middle Name:M
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9426
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-9426
Mailing Address - Country:US
Mailing Address - Phone:803-551-2900
Mailing Address - Fax:803-551-2979
Practice Address - Street 1:2800 BUSH RIVER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:803-551-2900
Practice Address - Fax:803-551-2979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC236172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236177Medicaid
SC236177Medicaid
SCG95611Medicare UPIN