Provider Demographics
NPI:1457397788
Name:RAO, GOWTHAM ADAMANE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GOWTHAM
Middle Name:ADAMANE
Last Name:RAO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHNSON AND JOHNSON PLZ
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08933-0002
Mailing Address - Country:US
Mailing Address - Phone:803-386-7890
Mailing Address - Fax:
Practice Address - Street 1:1 JOHNSON AND JOHNSON PLZ
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08933-8320
Practice Address - Country:US
Practice Address - Phone:803-386-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ68057208D00000X
SC34024208D00000X, 2083C0008X, 2083P0901X, 202D00000X, 207Q00000X, 207R00000X, 208000000X
WI52580-20208D00000X, 2083C0008X, 2083P0901X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics