Provider Demographics
NPI:1831164862
Name:RAO, RAMESH KADEKOPPAL (MD)
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:KADEKOPPAL
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1788
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-1788
Mailing Address - Country:US
Mailing Address - Phone:865-549-4892
Mailing Address - Fax:865-549-2762
Practice Address - Street 1:389 FORGE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752
Practice Address - Country:US
Practice Address - Phone:423-869-0725
Practice Address - Fax:423-869-9275
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD214182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065611Medicaid
TNTN0155OtherJOHN DEERE/UHC
TN5618128OtherAETNA
TN7323916OtherCIGNA
TN3706129Medicaid
TN4152612OtherBCBS
TN30656101Medicaid
TN30656101Medicaid
TN3065611Medicare ID - Type UnspecifiedIND
TN$$$$$$$$$OtherTRICARE
TN4152612OtherBCBS
TN3706129Medicaid
TN30656101Medicare PIN