Provider Demographics
NPI:1962480590
Name:RAO, AMBIKA (MD)
Entity Type:Individual
Prefix:
First Name:AMBIKA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6439 GARNERS FERRY ROAD
Mailing Address - Street 2:WJB DORN VA MEDICAL CENTER
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1613
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:803-647-5714
Practice Address - Street 1:6439 GARNERS FERRY ROAD
Practice Address - Street 2:BLDG 100, RM5C100B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1613
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-647-5714
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV7327207RE0101X
SC34359207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500484Medicaid
SC343596Medicaid
SCAA86152603OtherMEDICARE PTAN
NV002019560Medicaid
NV002019560Medicaid
NV002019560Medicaid
F97322Medicare UPIN
NVWQBHV08Medicare ID - Type UnspecifiedMEDICARE