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General NPI Number Information
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NPI Number | 1629106430
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Entity Type | Organization
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Legal Business Name | CAPITAL BRAIN CENTER, PA
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2800 BUSH RIVER RD STE 5
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City | COLUMBIA
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State | SC
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Zip | 29210-5662
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Country | US
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Telephone | 803-551-2900
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Fax | 803-551-2979
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Provider Business Mailing Address
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Address Line | PO BOX 9426
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City | COLUMBIA
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State | SC
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Zip | 29290-9426
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Country | US
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Telephone | 803-551-2900
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Fax | 803-551-2979
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUBBA M RAO
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Credential | M.D
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Telephone | 803-551-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 23617
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License Number State | SC
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