Provider Demographics
NPI:1619925856
Name:RAO, ANIL V (MD/OBGYN)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:V
Last Name:RAO
Suffix:
Gender:M
Credentials:MD/OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DRIVE
Mailing Address - Street 2:MAILBOX 117
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:260-266-8210
Mailing Address - Fax:
Practice Address - Street 1:2812 THEATER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-7978
Practice Address - Country:US
Practice Address - Phone:260-356-0000
Practice Address - Fax:260-358-9146
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030190A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089194OtherANTHEM
IN100138890Medicaid
IN371860Medicare PIN
IND94796Medicare UPIN