Provider Demographics
NPI:1851589162
Name:RAO, SAJAN KUCHIPUDI (MD)
Entity Type:Individual
Prefix:
First Name:SAJAN
Middle Name:KUCHIPUDI
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 1:625 9TH ST N
Mailing Address - Street 2:STE 104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8143
Mailing Address - Country:US
Mailing Address - Phone:239-963-9788
Mailing Address - Fax:239-963-9771
Practice Address - Street 1:625 9TH ST N
Practice Address - Street 2:STE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8143
Practice Address - Country:US
Practice Address - Phone:239-963-9788
Practice Address - Fax:239-963-9771
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC034810207RC0000X
FLME103253207RC0000X
DCMD034810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851589162Medicaid
DC039095800Medicaid
MD4135342 00Medicaid
DCP00616347OtherRAILROAD MEDICARE
DCP00616347OtherRAILROAD MEDICARE