Healthcare Provider Details

I. General information

NPI: 1699734533
Provider Name (Legal Business Name): JYOTHI P RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10207 CERNY ST STE 306
RALEIGH NC
27617-4887
US

IV. Provider business mailing address

10207 CERNY ST STE 306
RALEIGH NC
27617-4887
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-3600
  • Fax: 919-660-9201
Mailing address:
  • Phone: 919-684-3600
  • Fax: 919-660-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17129
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2008-01296
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: