1649265588 NPI number — MANDIGA V RAO MD

Table of content: MANDIGA V RAO MD (NPI 1649265588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649265588 NPI number — MANDIGA V RAO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAO
Provider First Name:
MANDIGA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649265588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15634-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-6517
Provider Business Mailing Address Fax Number:
724-523-6519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-527-3551
Provider Business Practice Location Address Fax Number:
724-527-6519
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD037131L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01075421606 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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