Provider Demographics
NPI:1578644977
Name:RAO, SIDDHARTHA ANNAMRAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDDHARTHA
Middle Name:ANNAMRAJU
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 1:3001 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1930
Mailing Address - Country:US
Mailing Address - Phone:727-474-0090
Mailing Address - Fax:727-474-0055
Practice Address - Street 1:1000 CRESCENT GRN STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8117
Practice Address - Country:US
Practice Address - Phone:919-630-1226
Practice Address - Fax:727-474-0055
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00449207R00000X
NC200400449207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1496Medicaid
NC2004-00449OtherMEDICAL LICENSE #
NC5918575Medicaid
NC2004-00449OtherMEDICAL LICENSE #
NCI12876Medicare UPIN