Provider Demographics
NPI:1609838853
Name:RAO, ABHAY V (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHAY
Middle Name:V
Last Name:RAO
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 1:1463 W HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4126
Mailing Address - Country:US
Mailing Address - Phone:480-854-8780
Mailing Address - Fax:480-854-8783
Practice Address - Street 1:221 S POWER RD
Practice Address - Street 2:#104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5205
Practice Address - Country:US
Practice Address - Phone:480-854-8780
Practice Address - Fax:480-854-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0815190OtherBCBS
AZ346735Medicaid
F72271Medicare UPIN
AZZ21601Medicare PIN