Provider Demographics
NPI:1669634614
Name:RAO, AGAM KUMARI (MD)
Entity Type:Individual
Prefix:DR
First Name:AGAM
Middle Name:KUMARI
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 1:631 LINWOOD AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4486
Mailing Address - Country:US
Mailing Address - Phone:917-971-6359
Mailing Address - Fax:
Practice Address - Street 1:631 LINWOOD AVE NE APT 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4486
Practice Address - Country:US
Practice Address - Phone:917-971-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243392207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine