Provider Demographics
NPI:1184676892
Name:RAO, NAGARAJ DHARMAVARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGARAJ
Middle Name:DHARMAVARAM
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NAGARAJ
Other - Middle Name:RAO
Other - Last Name:DHARMAVARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1113
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:JAMAICA HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-6000
Practice Address - Fax:631-454-4161
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212786207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY212786OtherNYS LICENSE
NY01977586Medicaid
NYG67641Medicare UPIN
NY212786OtherNYS LICENSE