Provider Demographics
NPI:1568416881
Name:RAO, MYTHRI R (MD)
Entity Type:Individual
Prefix:
First Name:MYTHRI
Middle Name:R
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 1:3589 QUEEN VICTORIA CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-5707
Mailing Address - Country:US
Mailing Address - Phone:937-433-8990
Mailing Address - Fax:
Practice Address - Street 1:33 W RAHN RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2219
Practice Address - Country:US
Practice Address - Phone:937-433-8990
Practice Address - Fax:937-433-8691
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083513R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00138956OtherRAIL ROAD MEDICARE
OH000000574727OtherANTHEM
OH000000336870OtherBCBS
OH2448882Medicaid
OH000000336870OtherBCBS
H97837Medicare UPIN
OHP00693459Medicare PIN
OH4121883Medicare PIN
RA4121882Medicare PIN