Basic Information
| Provider Information | |||||||||
| NPI: | 1932465317 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | V RAO EMANDI MD PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CANCER CARE CENTERS OF FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13904 LAKESHORE BLVD | ||||||||
| Address2: | #410 | ||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346671481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278625489 | ||||||||
| FaxNumber: | 7278620397 | ||||||||
| Practice Location | |||||||||
| Address1: | 5802 STATE ROAD 54 | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346526050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278422795 | ||||||||
| FaxNumber: | 7278428676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 04/10/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PANARISI | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7278627103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME36725 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 378675700 | 05 | FL | MEDICAID |