Provider Demographics
NPI:1386740074
Name:RAO, SANJEEV B N (MD)
Entity type:Individual
Prefix:
First Name:SANJEEV
Middle Name:B N
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5701 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-531-1770
Mailing Address - Fax:314-771-9485
Practice Address - Street 1:909 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3826
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-771-9485
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050286812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-612-668-4OtherECFMG
MO207610908Medicaid
MO207610908Medicaid