Healthcare Provider Details

I. General information

NPI: 1619464021
Provider Name (Legal Business Name): MYTHILI RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOPE DR STE 104
HERSHEY PA
17033-2008
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8550
  • Fax: 717-531-0086
Mailing address:
  • Phone: 717-531-5208
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD491151
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: