Provider Demographics
NPI:1164410825
Name:RAO, ADDAGADA C (MD)
Entity Type:Individual
Prefix:DR
First Name:ADDAGADA
Middle Name:C
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 1:145 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4439
Mailing Address - Country:US
Mailing Address - Phone:718-418-5900
Mailing Address - Fax:718-418-4368
Practice Address - Street 1:145 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4439
Practice Address - Country:US
Practice Address - Phone:718-418-5900
Practice Address - Fax:718-418-4368
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111527208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00200826Medicaid
90431OtherAETNA
D5087OtherOXFORD
D34170Medicare UPIN
D5087OtherOXFORD