Provider Demographics
NPI:1750604633
Name:SMITHA RAO PERSAUD, M.D., L.L.C.
Entity type:Organization
Organization Name:SMITHA RAO PERSAUD, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITHA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-881-5770
Mailing Address - Street 1:1425 WEATHERLY RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1178
Mailing Address - Country:US
Mailing Address - Phone:256-881-5770
Mailing Address - Fax:256-882-1410
Practice Address - Street 1:1425 WEATHERLY RD SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-1178
Practice Address - Country:US
Practice Address - Phone:256-881-5770
Practice Address - Fax:256-882-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL273972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI70341Medicare UPIN