Provider Demographics
NPI:1063478634
Name:BOINAPALLY, ARAVIND RAO (MD)
Entity Type:Individual
Prefix:
First Name:ARAVIND
Middle Name:RAO
Last Name:BOINAPALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BOINAPALLY
Other - Middle Name:
Other - Last Name:ARAVIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:
Practice Address - Street 1:3400 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7317
Practice Address - Country:US
Practice Address - Phone:919-954-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15383R207RN0300X
NC2008-01765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1193305Medicaid
LA4F819Medicare PIN
LA1193305Medicaid
LA4F819CC11Medicare PIN