Provider Demographics
NPI:1710917869
Name:RAO, CHETHANA (MD)
Entity Type:Individual
Prefix:
First Name:CHETHANA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3903 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2943
Mailing Address - Country:US
Mailing Address - Phone:703-870-3750
Mailing Address - Fax:703-594-8604
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 303
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-870-3750
Practice Address - Fax:703-865-6784
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0409727OtherEVERCARE
MD624762-01OtherBCBS
1710917869OtherBCBS-VA
0010OtherCAREFIRST BCBS
0409807OtherEVERCARE
P00185931Medicare PIN
0010OtherCAREFIRST BCBS
1710917869OtherBCBS-VA