Provider Demographics
NPI:1558616300
Name:HOLALAKERE SREENIVASA RAO, ANOOP KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANOOP KUMAR
Middle Name:
Last Name:HOLALAKERE SREENIVASA RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:243 ELM STREET
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2099
Practice Address - Country:US
Practice Address - Phone:603-542-7771
Practice Address - Fax:603-543-6950
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0201207Q00000X
NH17060207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025422Medicaid
NHT400243393OtherMEDICARE PTAN
NH3101868Medicaid