Provider Demographics
NPI:1912001090
Name:RAO, SADASHIVA (MD)
Entity Type:Individual
Prefix:
First Name:SADASHIVA
Middle Name:
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 1:1815 W 13TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-571-8958
Mailing Address - Fax:302-571-1320
Practice Address - Street 1:1815 W 13TH ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4054
Practice Address - Country:US
Practice Address - Phone:302-571-8958
Practice Address - Fax:302-571-1320
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002022208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000097101OtherEDS
000114676OtherAMERIHEALTH PERS CHOICE H
3138541OtherMAMSI
0080634000OtherKEYSTONE EAST
0000097101OtherDELAWARE PHYSICIANS
0080634000OtherAMERIHEALTH HMO
0000097101OtherDIAMOND STATE PARTNERS
P00270590OtherRAILROAD MEDICARE
061668248OtherBCBS
3138541OtherALLIANCE
3138541OtherOPTIMUM CHOICE
0000097101OtherDELAWARE PHYSICIANS
3138541OtherOPTIMUM CHOICE
P00270590OtherRAILROAD MEDICARE