Provider Demographics
NPI:1215013578
Name:RAO, ANITA G (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:G
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 1:500 NE MULTNOMAH ST
Mailing Address - Street 2:DEPT MLP ORTHO
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 SE PARK PLAZA DR
Practice Address - Street 2:STE 140
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5886
Practice Address - Country:US
Practice Address - Phone:360-449-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH46234Medicare UPIN