Provider Demographics
NPI:1912909763
Name:RAO, EDWIN J (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:J
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5630
Mailing Address - Fax:423-778-3146
Practice Address - Street 1:979 E. THIRD STREET
Practice Address - Street 2:SUITE #C-735
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-9101
Practice Address - Fax:423-778-9190
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-02-08
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Provider Licenses
StateLicense IDTaxonomies
TN52906207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA290007077OtherRAILROAD MEDICARE
PA692874F08Medicare PIN
PA0012356100004Medicaid