Provider Demographics
NPI:1023110780
Name:RAO, SRIDHAR A (MD)
Entity type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:A
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 1:7408 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7154
Mailing Address - Country:US
Mailing Address - Phone:407-381-7387
Mailing Address - Fax:407-636-7824
Practice Address - Street 1:7408 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7154
Practice Address - Country:US
Practice Address - Phone:407-381-7387
Practice Address - Fax:407-636-7824
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065434207Q00000X
FLME139249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3457161Medicaid
MIG82178Medicare UPIN
MIM23560101Medicare PIN