Healthcare Provider Details

I. General information

NPI: 1013396555
Provider Name (Legal Business Name): MADHUMATHI RAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax: 855-771-6849
Mailing address:
  • Phone: 612-273-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD048804
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: