Provider Demographics
NPI:1194038224
Name:RAO, VIDHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDHYA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SILVER LN
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5343
Mailing Address - Country:US
Mailing Address - Phone:203-380-5270
Mailing Address - Fax:203-380-5282
Practice Address - Street 1:999 SILVER LN
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5343
Practice Address - Country:US
Practice Address - Phone:203-380-5270
Practice Address - Fax:203-380-5282
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT51823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400087779Medicare PIN