Provider Demographics
NPI:1053636241
Name:RAO, ABIGAIL JUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JUSTINE
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2847
Practice Address - Country:US
Practice Address - Phone:502-394-6390
Practice Address - Fax:502-394-6388
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY51563207T00000X
CAA146390207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100569370Medicaid
KYK270630OtherMEDICARE