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NPI Code Detail

MEDICARE: DR. SHANE WYATT RAU MD PHD

MEDICARE: DR. SHANE WYATT RAU MD PHD
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
12084P0800XPsychiatry Physician0101239499VA
22084P0800XPsychiatry Physician2008-01020NC
32084P0800XPsychiatry Physician036157408IL

General Provider Information

NPI Number : 1811925803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE WYATT RAU MD PHD
Provider Business Mailing Address
First Line : 5483 MOORETOWN RD
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-2108
Country : US
Telephone Number : 757-941-6400
Fax Number : 757-941-6419
Provider Business Practice Location Address
First Line : 5483 MOORETOWN RD
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-2108
Country : US
Telephone Number : 757-941-6400
Fax Number : 757-941-6419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 09/13/2024

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