MEDICARE: PRAKASHCHANDRA M RAO MD

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	174400000X	Specialist	129784	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	:	1376647511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASHCHANDRA M RAO MD

Provider Business Mailing Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE 1K
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-365-7255
Fax Number	:	718-365-7558

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE 1K
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-365-7255
Fax Number	:	718-365-7558

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	04/22/2015

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