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General NPI Number Information
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NPI Number | 1699332932
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Entity Type | Individual
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Provider Name | SANJAY PRAKASH RAU DO
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Gender | Male
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 10800 KNIGHTS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-4200
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Country | US
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Telephone | 617-827-3596
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Fax |
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Provider Business Mailing Address
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Address Line | 10800 KNIGHTS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-4200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 280722
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 281066
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | OT020276
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License Number State | PA
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