=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669415592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INNANJE RAVINDRANATH RAO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1423 E FRANKLIN ST SUITE B
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28112-5266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-283-6953
-----------------------------------------------------
Fax | 704-283-0228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60122
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-0122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-512-4808
-----------------------------------------------------
Fax | 704-512-4838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 19943
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------