Provider Demographics
NPI:1457397903
Name:RAO, RAMAKRISHNA PEMMARAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAKRISHNA
Middle Name:PEMMARAJU
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 MCKINNEY AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1488
Mailing Address - Country:US
Mailing Address - Phone:682-330-0427
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-588-0800
Practice Address - Fax:502-588-0801
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA552822084P0800X, 2084P0804X
IL0361632072084P0800X
TXH2590207R00000X
TXH52902084P0800X, 2084P0804X
GA0526252084P0800X, 2084P0804X
VA01010538492084P0804X
KYC07702084P0804X
IN01059464A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612525Medicare PIN
TXE67276Medicare UPIN