Provider Demographics
NPI:1043303688
Name:RAO, REVATI ARJUN (MD)
Entity Type:Individual
Prefix:DR
First Name:REVATI
Middle Name:ARJUN
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2014 WASHINGTON STREET
Mailing Address - Street 2:NEW ENGLAND HEMATOLOGY ONCOLOGY
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-658-6000
Mailing Address - Fax:617-658-6001
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEW ENGLAND HEMATOLOGY ONCOLOGY
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-658-6000
Practice Address - Fax:617-658-6001
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA212470207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084220AMedicaid
I46668Medicare UPIN
MA1296001Medicare PIN