Provider Demographics
NPI:1366621906
Name:SANJAI C. RAO D.O., INC.
Entity type:Organization
Organization Name:SANJAI C. RAO D.O., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAI
Authorized Official - Middle Name:CHAMKUR
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-477-0121
Mailing Address - Street 1:3521 SILVERSIDE RD
Mailing Address - Street 2:QUILLEN BLDG, SUITE 2I-2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4900
Mailing Address - Country:US
Mailing Address - Phone:302-477-0121
Mailing Address - Fax:302-477-0223
Practice Address - Street 1:3521 SILVERSIDE RD
Practice Address - Street 2:QUILLEN BLDG, SUITE 2I-2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-477-0121
Practice Address - Fax:302-477-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC200077002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I45237Medicare UPIN