Provider Demographics
NPI:1528012325
Name:KOSARAJU, RAO R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAO
Middle Name:R
Last Name:KOSARAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOSARAJU
Other - Middle Name:R
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1731
Mailing Address - Country:US
Mailing Address - Phone:510-373-3000
Mailing Address - Fax:510-744-9959
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:SUITE L
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1731
Practice Address - Country:US
Practice Address - Phone:510-373-3000
Practice Address - Fax:510-744-9959
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43123207KA0200X
CAA30703207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0043790Medicaid
INE91078Medicare UPIN
CAZZZ21572ZMedicare PIN
IN234250AMedicare ID - Type Unspecified