Healthcare Provider Details

I. General information

NPI: 1871605378
Provider Name (Legal Business Name): THOTA RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-8484
  • Fax: 317-880-0498
Mailing address:
  • Phone: 317-880-8484
  • Fax: 317-880-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01037248A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: