MEDICARE: DR. ANAND VASIST RAO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS031366L	PA

General Provider Information

NPI Number	:	1063506939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANAND VASIST RAO DMD

Provider Business Mailing Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 950
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-567-0110
Fax Number	:	215-864-0496

Provider Business Practice Location Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 950
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-567-0110
Fax Number	:	215-864-0496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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