Provider Demographics
NPI:1093851917
Name:RAO, PADMAREKHA B (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAREKHA
Middle Name:B
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REKHA
Other - Middle Name:B
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14 WOODWARD DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3363
Mailing Address - Country:US
Mailing Address - Phone:732-360-2888
Mailing Address - Fax:
Practice Address - Street 1:14 WOODWARD DR STE A
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3374
Practice Address - Country:US
Practice Address - Phone:732-360-2888
Practice Address - Fax:732-360-4888
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA067668002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7748108Medicaid
NJ7748108Medicaid
NJ063444Medicare ID - Type Unspecified