Provider Demographics
NPI:1831395359
Name:RAO, POORNIMA (MD)
Entity type:Individual
Prefix:
First Name:POORNIMA
Middle Name:
Last Name:RAO
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 1:12311 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8344
Mailing Address - Country:US
Mailing Address - Phone:724-941-7490
Mailing Address - Fax:724-941-5231
Practice Address - Street 1:12311 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8344
Practice Address - Country:US
Practice Address - Phone:724-941-7490
Practice Address - Fax:724-941-5231
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419873207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019201140009Medicaid
OH2752794Medicaid
WV3810009314Medicaid
WV3810009314Medicaid
OH2752794Medicaid