Basic Information
| Provider Information | |||||||||
| NPI: | 1962480590 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RAO | ||||||||
| FirstName: | AMBIKA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6439 GARNERS FERRY ROAD | ||||||||
| Address2: | WJB DORN VA MEDICAL CENTER | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | 8036475714 | ||||||||
| Practice Location | |||||||||
| Address1: | 6439 GARNERS FERRY ROAD | ||||||||
| Address2: | BLDG 100, RM5C100B | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | 8036475714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 7327 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 34359 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | BR4321434 | 01 | NV | DEA | OTHER | 100500484 | 05 | NV | MEDICAID | 343596 | 05 | SC | MEDICAID | AA86152603 | 01 | SC | MEDICARE PTAN | OTHER | 002019560 | 05 | NV | MEDICAID |