Provider Demographics
NPI:1790887909
Name:RAO, BHAVANI PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:PRAKASH
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 1:1819 OAKTREE ROAD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-757-6655
Mailing Address - Fax:908-322-5509
Practice Address - Street 1:1819 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2740
Practice Address - Country:US
Practice Address - Phone:908-757-6655
Practice Address - Fax:908-757-6653
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06751900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8159301Medicaid
G96457Medicare UPIN
028275Medicare ID - Type Unspecified