Healthcare Provider Details

I. General information

NPI: 1992811376
Provider Name (Legal Business Name): RAJU RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PINE LAKE RD SUITE 111
LINCOLN NE
68516-5497
US

IV. Provider business mailing address

201 S 68TH STREET PL STE 200
LINCOLN NE
68510-2496
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax: 402-420-7240
Mailing address:
  • Phone: 402-420-7000
  • Fax: 402-420-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number19624
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: