MEDICARE: AMBIKA RAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	7327	NV
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	34359	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AA86152603	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962480590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBIKA RAO M.D.

Provider Business Mailing Address
First Line	:	6439 GARNERS FERRY ROAD
Second Line	:	WJB DORN VA MEDICAL CENTER
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1613
Country	:	US
Telephone Number	:	803-776-4000
Fax Number	:	803-647-5714

Provider Business Practice Location Address
First Line	:	6439 GARNERS FERRY ROAD
Second Line	:	BLDG 100, RM5C100B
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1613
Country	:	US
Telephone Number	:	803-776-4000
Fax Number	:	803-647-5714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/07/2023

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