Healthcare Provider Details

I. General information

NPI: 1366621906
Provider Name (Legal Business Name): SANJAI C. RAO D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 SILVERSIDE RD QUILLEN BLDG, SUITE 2I-2
WILMINGTON DE
19810-4900
US

IV. Provider business mailing address

3521 SILVERSIDE RD QUILLEN BLDG, SUITE 2I-2
WILMINGTON DE
19810-4900
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-0121
  • Fax: 302-477-0223
Mailing address:
  • Phone: 302-477-0121
  • Fax: 302-477-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC20007700
License Number StateDE

VIII. Authorized Official

Name: DR. SANJAI CHAMKUR RAO
Title or Position: OWNER
Credential: D.O.
Phone: 302-477-0121