Basic Information
| Provider Information | |||||||||
| NPI: | 1578644977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | SIDDHARTHA | ||||||||
| MiddleName: | ANNAMRAJU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 PALM HARBOR BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346831930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274740090 | ||||||||
| FaxNumber: | 7274740055 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 CRESCENT GRN STE 102 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275188117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196301226 | ||||||||
| FaxNumber: | 7274740055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2004-00449 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 200400449 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 200400449 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | NC1496 | 05 | SC | MEDICAID | 2004-00449 | 01 | NC | MEDICAL LICENSE # | OTHER | 5918575 | 05 | NC | MEDICAID |