Provider Demographics
NPI:1023073327
Name:RAO, SATHISHCHANDRA N (MD)
Entity type:Individual
Prefix:
First Name:SATHISHCHANDRA
Middle Name:N
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 58187
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25358-0187
Mailing Address - Country:US
Mailing Address - Phone:304-792-6275
Mailing Address - Fax:304-792-6290
Practice Address - Street 1:38 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-792-6255
Practice Address - Fax:304-792-6290
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083861000Medicaid
WV0083861000Medicaid
WVD49501Medicare UPIN