Healthcare Provider Details

I. General information

NPI: 1053661306
Provider Name (Legal Business Name): RAMYA BHAT RAO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-2217
US

IV. Provider business mailing address

1749 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-2217
US

V. Phone/Fax

Practice location:
  • Phone: 617-491-1161
  • Fax:
Mailing address:
  • Phone: 215-837-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1857079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: