Healthcare Provider Details

I. General information

NPI: 1972941318
Provider Name (Legal Business Name): SRINIVAS RAO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 KATY FWY STE 115
HOUSTON TX
77079-2105
US

IV. Provider business mailing address

3820 NORTHDALE BLVD STE 201
TAMPA FL
33624-1893
US

V. Phone/Fax

Practice location:
  • Phone: 281-888-1464
  • Fax: 713-640-5938
Mailing address:
  • Phone: 800-991-6117
  • Fax: 813-434-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SRINIVAS P RAO
Title or Position: PRESIDENT
Credential: MD
Phone: 713-240-4913