Provider Demographics
NPI:1245288505
Name:RAO, RAVI (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
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 1:3822 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5845
Mailing Address - Country:US
Mailing Address - Phone:321-636-6914
Mailing Address - Fax:321-636-6916
Practice Address - Street 1:3822 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5845
Practice Address - Country:US
Practice Address - Phone:321-636-6914
Practice Address - Fax:321-636-6916
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089867207RI0011X
FLME96842207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA886YMedicare UPIN