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General NPI Number Information
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NPI Number | 1821356353
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Entity Type | Organization
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Legal Business Name | RAMAKRISHNA PEMMARAJU RAO MD
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 6410 SOUTHWEST BLVD STE 225
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City | BENBROOK
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State | TX
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Zip | 76109-3920
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Country | US
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Telephone | 214-551-1008
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Fax | 817-625-3062
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Provider Business Mailing Address
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Address Line | 6410 SOUTHWEST BLVD STE 225
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City | BENBROOK
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State | TX
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Zip | 76109-3920
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Country | US
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Telephone | 817-570-9977
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Fax | 817-625-3062
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Authorized Official
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Title or Position | PHYSCIAN
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Name | DR. RAMAKRISHNA PEMMARAJU RAO II
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Credential | M.D
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Telephone | 817-570-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | H5290
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License Number State | TX
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