Provider Demographics
NPI:1629098033
Name:RAO, PADMA GANTA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PADMA
Middle Name:GANTA
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:105 WINDSOR PATH, STE: 2
Mailing Address - Street 2:PADMA RAO SCOTT COUNTY FAMILY PRACTICE, PLLC
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324
Mailing Address - Country:US
Mailing Address - Phone:502-863-4485
Mailing Address - Fax:502-863-4487
Practice Address - Street 1:105 WINDSOR PATH, STE: 2
Practice Address - Street 2:PADMA RAO SCOTT COUNTY FAMILY PRACTICE, PLLC
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-863-4485
Practice Address - Fax:502-863-4487
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-09-11
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Provider Licenses
StateLicense IDTaxonomies
KY37079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000329732OtherANTHEM PIN
KY64045883Medicaid
KYH55971Medicare UPIN
KY64045883Medicaid