Provider Demographics
NPI:1962673558
Name:RAO, NIRANJAN (MD)
Entity Type:Individual
Prefix:
First Name:NIRANJAN
Middle Name:
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 1:9710 62ND DR
Mailing Address - Street 2:7E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1343
Mailing Address - Country:US
Mailing Address - Phone:718-530-5676
Mailing Address - Fax:
Practice Address - Street 1:9710 62ND DR
Practice Address - Street 2:7E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1343
Practice Address - Country:US
Practice Address - Phone:718-530-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
76366Medicare PIN