Provider Demographics
NPI:1821356353
Name:RAMAKRISHNA PEMMARAJU RAO MD
Entity Type:Organization
Organization Name:RAMAKRISHNA PEMMARAJU RAO MD
Other - Org Name:RAMA PEMMARAJU RAO MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:PEMMARAJU
Authorized Official - Last Name:RAO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:817-570-9977
Mailing Address - Street 1:6410 SOUTHWEST BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3920
Mailing Address - Country:US
Mailing Address - Phone:817-570-9977
Mailing Address - Fax:817-625-3062
Practice Address - Street 1:6410 SOUTHWEST BLVD STE 225
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3920
Practice Address - Country:US
Practice Address - Phone:214-551-1008
Practice Address - Fax:817-625-3062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAMA PEMMARAJU RAO MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-03
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH52902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE67276Medicare UPIN