Provider Demographics
NPI:1477609873
Name:RAO, VIDYA JULURU (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:JULURU
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 1:25 WINDING RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7156
Mailing Address - Country:US
Mailing Address - Phone:732-868-0589
Mailing Address - Fax:
Practice Address - Street 1:25 WINDING RIDGE WAY
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7156
Practice Address - Country:US
Practice Address - Phone:732-868-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03148100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6506305Medicaid
NJ6506305Medicaid
544968Medicare ID - Type Unspecified