Healthcare Provider Details

I. General information

NPI: 1104862028
Provider Name (Legal Business Name): RAO HANUMANTH ANDAVOLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 US HIGHWAY 1
PRINCETON NJ
08540-5922
US

IV. Provider business mailing address

9 JUSTICE COURT
PRINCETON NJ
08540-2332
US

V. Phone/Fax

Practice location:
  • Phone: 609-734-7600
  • Fax: 609-452-7577
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number25MA05440700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA05440700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: