Healthcare Provider Details

I. General information

NPI: 1366607541
Provider Name (Legal Business Name): ATUL SADASHIV RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W STATE ST
DOYLESTOWN PA
18901-2554
US

IV. Provider business mailing address

595 W STATE ST 1ST FLOOR WEST WING
DOYLESTOWN PA
18901-2554
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2100
  • Fax: 215-345-2110
Mailing address:
  • Phone: 412-802-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD424209
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102491134
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: