Healthcare Provider Details

I. General information

NPI: 1710187687
Provider Name (Legal Business Name): AMULYA A NAGESWARA RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMULYA A NAGESWARARAO

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FIRST STREET SW MAYO CLINIC
ROCHESTER MN
55905
US

IV. Provider business mailing address

200 FIRST STREET SW MAYO CLINIC
ROCHESTER MN
55905
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49916
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD038778
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number49916
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: