Provider Demographics
NPI:1447212238
Name:RAU, PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:
Last Name:RAU
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 1:1681 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7948
Mailing Address - Country:US
Mailing Address - Phone:781-848-6040
Mailing Address - Fax:781-843-1314
Practice Address - Street 1:1681 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7948
Practice Address - Country:US
Practice Address - Phone:781-848-6040
Practice Address - Fax:781-843-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39034207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6128OtherHARVARD PILGRIM
MA2069008Medicaid
MA039034OtherTUFTS HEALTH PLAN
MAC03040OtherBLUE CROSS
MA2069008Medicaid
MAC03040Medicare PIN