Provider Demographics
NPI:1356441265
Name:RAO, GEETHA P (MD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:P
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 1:719 WEST NYACK ROAD
Mailing Address - Street 2:SUITE #30
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2241
Mailing Address - Country:US
Mailing Address - Phone:845-358-9102
Mailing Address - Fax:845-358-0091
Practice Address - Street 1:719 WEST NYACK ROAD
Practice Address - Street 2:SUITE #30
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2241
Practice Address - Country:US
Practice Address - Phone:845-358-9102
Practice Address - Fax:845-358-0091
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00761486Medicaid
RP044OtherOXFORD
20397OtherAETNA
NY00761486Medicaid
20397OtherAETNA