Provider Demographics
NPI:1821135070
Name:RAO, SUMAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:S
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 1:4100 SW I ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-0200
Mailing Address - Country:US
Mailing Address - Phone:479-636-9234
Mailing Address - Fax:
Practice Address - Street 1:4100 SW I ST STE 100
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-0200
Practice Address - Country:US
Practice Address - Phone:479-636-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007691208000000X
ARE-15451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205808900Medicaid
10854558OtherCAQH PROVIDER ID
MO205808900Medicaid
MOH44911Medicare UPIN
MO918183230Medicare ID - Type UnspecifiedMO MDCR #