Provider Demographics
NPI:1851350615
Name:RAO, NIRANJAN V (MD)
Entity Type:Individual
Prefix:
First Name:NIRANJAN
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 1:75 VERONICA AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5002
Mailing Address - Country:US
Mailing Address - Phone:732-249-0360
Mailing Address - Fax:732-249-0035
Practice Address - Street 1:75 VERONICA AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-249-0360
Practice Address - Fax:732-249-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0774500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD68811Medicare UPIN
178461A24Medicare ID - Type Unspecified