Healthcare Provider Details

I. General information

NPI: 1457397903
Provider Name (Legal Business Name): RAMAKRISHNA PEMMARAJU RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 HUEBNER RD
SAN ANTONIO TX
78240-1803
US

IV. Provider business mailing address

3839 MCKINNEY AVE STE 155
DALLAS TX
75204-1488
US

V. Phone/Fax

Practice location:
  • Phone: 210-541-5300
  • Fax:
Mailing address:
  • Phone: 682-330-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH5290
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036163207
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number052625
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01059464A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101053849
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA55282
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH5290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: