Healthcare Provider Details

I. General information

NPI: 1164410825
Provider Name (Legal Business Name): ADDAGADA C RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SAINT NICHOLAS AVE
BROOKLYN NY
11237-4439
US

IV. Provider business mailing address

145 SAINT NICHOLAS AVE
BROOKLYN NY
11237-4439
US

V. Phone/Fax

Practice location:
  • Phone: 718-418-5900
  • Fax: 718-418-4368
Mailing address:
  • Phone: 718-418-5900
  • Fax: 718-418-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: