Provider Demographics
NPI:1942242102
Name:RAO, SREENIVAS V (MD)
Entity Type:Individual
Prefix:
First Name:SREENIVAS
Middle Name:V
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7951
Mailing Address - Fax:843-777-7981
Practice Address - Street 1:401 E CHEVES ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2615
Practice Address - Country:US
Practice Address - Phone:843-777-7951
Practice Address - Fax:843-777-7981
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21509207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC900002967OtherRAILROAD MEDICARE
NC89063RGMedicaid
SC215092Medicaid
SC900002967OtherRAILROAD MEDICARE
NC89063RGMedicaid