Basic Information
| Provider Information | |||||||||
| NPI: | 1013103084 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | V. RAO EMANDI MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CANCER CARE CENTERS OF FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13904 LAKESHORE BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346671481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278625489 | ||||||||
| FaxNumber: | 7278620397 | ||||||||
| Practice Location | |||||||||
| Address1: | 13904 LAKESHORE BLVD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346671481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278625489 | ||||||||
| FaxNumber: | 7278620397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EMANDI | ||||||||
| AuthorizedOfficialFirstName: | VENKATA | ||||||||
| AuthorizedOfficialMiddleName: | RAO | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7278625489 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 208800000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 207RX0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 378675700 | 05 | FL | MEDICAID |