Provider Demographics
NPI:1205851292
Name:RAO, BRINDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRINDA
Middle Name:E
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 1:305 N 3RD ST
Mailing Address - Street 2:OXFORD PROFESSIONAL CENTER
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1429
Mailing Address - Country:US
Mailing Address - Phone:610-932-9118
Mailing Address - Fax:610-932-8511
Practice Address - Street 1:305 N 3RD ST
Practice Address - Street 2:OXFORD PROFESSIONAL CENTER
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1429
Practice Address - Country:US
Practice Address - Phone:610-932-9118
Practice Address - Fax:610-932-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031406-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010592270001OtherMEDICAL ASSISTANCE
PAE64099Medicare UPIN