Provider Demographics
NPI:1558756221
Name:RAO, TEJUSVE (DO)
Entity Type:Individual
Prefix:
First Name:TEJUSVE
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W CAMDEN ST STE 801
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2565
Mailing Address - Country:US
Mailing Address - Phone:667-214-2055
Mailing Address - Fax:410-244-6080
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-6332
Practice Address - Fax:410-328-8028
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDH85506207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program