MEDICARE: DR. NAGARAJ DHARMAVARAM RAO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	212786	NY
2	207R00000X	Internal Medicine Physician	212786	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212786	OTHER	NY	NYS LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184676892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGARAJ DHARMAVARAM RAO MD

Provider Business Mailing Address
First Line	:	2800 MARCUS AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1113
Country	:	US
Telephone Number	:	516-622-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:	JAMAICA HOSPITAL EMERGENCY DEPARTMENT
City	:	JAMAICA
State	:	NY
Zip	:	11418-2897
Country	:	US
Telephone Number	:	718-206-6000
Fax Number	:	631-454-4161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/01/2015

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