Healthcare Provider Details

I. General information

NPI: 1295716157
Provider Name (Legal Business Name): RAO V VINNAKOTA M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 PARK AVE
SOUTH PLAINFIELD NJ
07080-5401
US

IV. Provider business mailing address

6 RAVINN LN
WARREN NJ
07059-5572
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-2662
  • Fax: 908-753-2633
Mailing address:
  • Phone: 908-753-2662
  • Fax: 908-753-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA02514200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: