Provider Demographics
NPI:1780791251
Name:RAO, RAMANATH S (MD)
Entity type:Individual
Prefix:
First Name:RAMANATH
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMANATH
Other - Middle Name:S
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:37852 MEDICAL ARTS CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4325
Mailing Address - Country:US
Mailing Address - Phone:813-788-0439
Mailing Address - Fax:813-788-6194
Practice Address - Street 1:37852 MEDICAL ARTS CT
Practice Address - Street 2:UNIT A
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4325
Practice Address - Country:US
Practice Address - Phone:813-788-0439
Practice Address - Fax:813-788-6194
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377090700Medicaid
FLF79961Medicare UPIN
FL377090700Medicaid