Active NPI
Kancherla Rao, M.D.
- Adolescent Medicine (Family Medicine) Physician
- Lorain, OH
National Provider Identifier
1154461572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adolescent Medicine (Family Medicine) Physician
- License
- 35046832
- Practice address
- 6140 S Broadway
Lorain, OH 44053-3821 - Phone
- (440) 204-4364
- Fax
- (440) 233-9070
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent Medicine (Family Medicine) Physician | 207QA0000X | 35046832 | OH | Primary |
Addresses
Primary practice location
6140 S Broadway
Lorain, OH 44053-3821
Mailing address
11124 Woodbury Lane
Elyria, OH 44035
Phone (440) 877-1859
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0069823 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35046832 | OH | MD | Adolescent Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361232000000",
"number": "1154461572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11124 WOODBURY LANE",
"city": "ELYRIA",
"state": "OH",
"postal_code": "44035",
"telephone_number": "440-877-1859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6140 S BROADWAY",
"city": "LORAIN",
"state": "OH",
"postal_code": "440533821",
"telephone_number": "440-204-4364",
"fax_number": "440-233-9070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAO",
"first_name": "KANCHERLA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2013-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0000X",
"taxonomy_group": "",
"desc": "Family Medicine, Adolescent Medicine",
"state": "OH",
"license": "35046832",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0069823",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.