Basic Information
| Provider Information | |||||||||
| NPI: | 1255325643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUNDAR RAO | ||||||||
| FirstName: | CORINNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175336100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655369210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175336100 | ||||||||
| FaxNumber: | 4175336740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 06/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 106490 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 106490 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00244830 | 01 | MO | RAILROAD MEDICARE | OTHER | 008013557 | 01 | MO | MEDICARE PTAN | OTHER | 106490 | 01 | MO | LICENSE | OTHER | 205212608 | 05 | MO | MEDICAID |