Healthcare Provider Details

I. General information

NPI: 1629068648
Provider Name (Legal Business Name): DALIPARTHY VENUGOPALA RAO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 STONELEIGH AVE
CARMEL NY
10512-2400
US

IV. Provider business mailing address

1071 STONELEIGH AVE
CARMEL NY
10512-2400
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-6116
  • Fax: 845-225-6126
Mailing address:
  • Phone: 845-225-6116
  • Fax: 845-225-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number137134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: