Provider Demographics
NPI:1821059072
Name:RAO DILLAWAY, MARGUERITE (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:RAO DILLAWAY
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 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3691
Mailing Address - Country:US
Mailing Address - Phone:203-287-5400
Mailing Address - Fax:203-281-3001
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-287-5400
Practice Address - Fax:203-281-3001
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0262922080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001262922Medicaid
CT1249063OtherUNITED HEALTHCARE
CTNHP224OtherOXFORD
CT726292OtherCONNECTICARE
CT010026292201CT02OtherANTHEM
CT0Q1595OtherHEALTHNET
CT001262922Medicaid