Provider Demographics
NPI:1235142142
Name:RAO, DEVAGUPTAPU BHASKAR (MD)
Entity type:Individual
Prefix:DR
First Name:DEVAGUPTAPU BHASKAR
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTURIAN DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2137
Mailing Address - Country:US
Mailing Address - Phone:302-543-8100
Mailing Address - Fax:302-543-8905
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:SUITE 307
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-543-8100
Practice Address - Fax:302-543-8905
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1000060622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2101752000OtherPENNSYLVANIA BLUE CROSS
MD467501100Medicaid
510315372001OtherCHAMPUS
H55353OtherFIRST STATE HEALTH PLAN
DE0001181001Medicaid
2101752000OtherDELAWARE VALLEY HMO
231653OtherMAMSI
H55353OtherMID ATLANTIC
231653OtherOPTIMUM CHOICE
NJ8756503Medicaid
DEBLUE CROSSOtherDELAWARE BLUE CROSS
DE009039S28Medicare ID - Type Unspecified
DE0001181001Medicaid
231653OtherOPTIMUM CHOICE
770003027Medicare ID - Type UnspecifiedRAILROAD MEDICARE