Healthcare Provider Details

I. General information

NPI: 1215467246
Provider Name (Legal Business Name): RAHUL RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE STE 500
FORT WORTH TX
76104-7304
US

IV. Provider business mailing address

2130 W CENTRAL AVE
TOLEDO OH
43606-3818
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-4280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT213969
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberU9339
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.142016
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberU9339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: