Provider Demographics
NPI:1295823656
Name:GOGINENI, R RAO (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:RAO
Last Name:GOGINENI
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 307
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:856-541-6137
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037942L2084P0800X, 2084P0804X
NJMA376422084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
010003755OtherAMERICHOICE
092269000OtherMEGELLAN
NJ5352100Medicaid
1122746OtherHORIZON NJ HEALTH
001663798OtherAMERIHEALTH PPO
260048933OtherRR MEDICARE
0821236000OtherAMERIHEALTH HMO, KEYSTONE, IBC
2388936OtherUNITED HEALTHCARE
33353OtherUNIVERSITY HEALTHPLAN
3K6031OtherHEALTHNET
4478422OtherAETNA
P2157639OtherOXFORD HEALTH PLAN
33353OtherUNIVERSITY HEALTHPLAN
B33804Medicare UPIN