MEDICARE: AC RAO PC

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	208600000X	Surgery Physician	111527	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306999792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC RAO PC

Provider Business Mailing Address
First Line	:	145 SAINT NICHOLAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 SAINT NICHOLAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4439
Country	:	US
Telephone Number	:	718-417-4606
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ADDAGADA C RAO
Credential	:
Telephone Number	:	718-417-4606

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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