Provider Demographics
NPI:1659481661
Name:RAMA RAO, ANIL PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:PRASAD
Last Name:RAMA RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANIL
Other - Middle Name:R
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3801 N CAMPBELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1448
Mailing Address - Country:US
Mailing Address - Phone:520-298-5454
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1417
Practice Address - Country:US
Practice Address - Phone:608-263-8443
Practice Address - Fax:608-262-7174
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29468207ZP0102X
WI2703-320207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ595431Medicaid
MN417016Medicare UPIN