Provider Demographics
NPI:1053582726
Name:RAO S. BHATRAJU, MD, PSC
Entity type:Organization
Organization Name:RAO S. BHATRAJU, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHATRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-0168
Mailing Address - Street 1:180 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1698
Mailing Address - Country:US
Mailing Address - Phone:606-432-0168
Mailing Address - Fax:606-432-0639
Practice Address - Street 1:180 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1698
Practice Address - Country:US
Practice Address - Phone:606-432-0168
Practice Address - Fax:606-432-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0125158000OtherWV MEDICAID
KY1409437OtherUMWA FUNDS
KY000000050525OtherBC/BS OF KY
VA098169OtherBS/BS OF VA
KYK010543OtherCHAMPUS
KY64275597Medicaid
KY000000050525OtherBC/BS OF KY
WV0125158000OtherWV MEDICAID