Provider Demographics
NPI:1669415592
Name:RAO, INNANJE RAVINDRANATH (MD)
Entity type:Individual
Prefix:DR
First Name:INNANJE
Middle Name:RAVINDRANATH
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0122
Mailing Address - Country:US
Mailing Address - Phone:704-512-4808
Mailing Address - Fax:704-512-4838
Practice Address - Street 1:1423 E FRANKLIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5266
Practice Address - Country:US
Practice Address - Phone:704-283-6953
Practice Address - Fax:704-283-0228
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19943207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267168Medicaid
NC70415OtherBCBS
NCP00612312OtherRAILROAD MEDICARE
NC8970415Medicaid
NCP00612312OtherRAILROAD MEDICARE
NC8970415Medicaid
SC267168Medicaid
NC209811GMedicare PIN