Provider Demographics
NPI:1083646756
Name:RAO, NAGARAJ SL (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGARAJ
Middle Name:SL
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 1:3 PINE LN
Mailing Address - Street 2:BOX 1056
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-1217
Mailing Address - Country:US
Mailing Address - Phone:814-757-8355
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN DR
Practice Address - Street 2:
Practice Address - City:NORTH WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5001
Practice Address - Country:US
Practice Address - Phone:814-726-4317
Practice Address - Fax:814-726-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032560E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
080037545OtherRAILROAD MEDICARE #
080037545OtherRAILROAD MEDICARE #
PAC59102Medicare UPIN