Provider Demographics
NPI:1508883133
Name:RAO, FAYE E (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:E
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:E
Other - Last Name:LIALIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL CARE WAY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7013
Mailing Address - Country:US
Mailing Address - Phone:334-305-2800
Mailing Address - Fax:334-305-2801
Practice Address - Street 1:200 MEDICAL CARE WAY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-7013
Practice Address - Country:US
Practice Address - Phone:334-305-2800
Practice Address - Fax:334-305-2801
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29578207RC0000X
MO2005016792207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
199938OtherMO-BLUE SHIELD
MO207422809Medicaid
AL102I064227Medicare PIN