Provider Demographics
NPI:1063615136
Name:RAO, ARCHANA (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARCHANA
Other - Middle Name:
Other - Last Name:SUBRAMANYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1420 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2208
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-366-6430
Practice Address - Street 1:13154 COIT RD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5773
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-366-6430
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAB2210877-4287390200000X
TXM8276207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAB2210877-4287OtherTRAINEE PERMIT