Provider Demographics
NPI:1518960913
Name:RAO, BHASKAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:BHASKAR
Middle Name:N
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-09-27
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TN13031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0527739Medicaid
MO205039803Medicaid
ME422400000Medicaid
LA1533912Medicaid
OH2004388Medicaid
VA006700152Medicaid
WY1135333 00Medicaid
AR132323001Medicaid
MS00117993Medicaid
OK9113031Medicaid
SCQ13031Medicaid
MI104677731Medicaid
AL009913940Medicaid
TX060501601Medicaid
TN3808915Medicaid
KY64926793Medicaid
NC7612994Medicaid
SCQ13031Medicaid
TX060501601Medicaid