Provider Demographics
NPI:1982834412
Name:RAO, PURNIMA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:R
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PURNIMA
Other - Middle Name:RAO
Other - Last Name:JANMEJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:985 SR 436
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5664
Mailing Address - Country:US
Mailing Address - Phone:407-831-5252
Mailing Address - Fax:407-831-3390
Practice Address - Street 1:985 SR 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3390
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045931207R00000X
FLME111655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005634000Medicaid
FLP01307044OtherPALMETTO PGBA
FLFS428WMedicare PIN
FL005634000Medicaid
FLFS428XMedicare PIN
FLP01307044OtherPALMETTO PGBA