Provider Demographics
NPI:1790730992
Name:RAO, ANURADHA TN (MD)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:TN
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BELLEVIEW AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1838
Mailing Address - Country:US
Mailing Address - Phone:540-981-7037
Mailing Address - Fax:540-342-1757
Practice Address - Street 1:2220 OLD BRICK ROAD
Practice Address - Street 2:APT 2421
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2306
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL 428532085R0202X
VA01012654362085R0202X
TXFTL 419352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7135OtherBCBSTX
TX178460501Medicaid
TX178460503OtherCSHCN
TXI48423Medicare UPIN
TX8S7135OtherBCBSTX
TX178460503OtherCSHCN