MEDICARE: DR. INNANJE RAVINDRANATH 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	207RC0000X	Cardiovascular Disease Physician	19943	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00612312	OTHER	NC	RAILROAD MEDICARE

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
2	70415	OTHER	NC	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669415592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INNANJE RAVINDRANATH RAO MD

Provider Business Mailing Address
First Line	:	PO BOX 60122
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0122
Country	:	US
Telephone Number	:	704-512-4808
Fax Number	:	704-512-4838

Provider Business Practice Location Address
First Line	:	1423 E FRANKLIN ST
Second Line	:	SUITE B
City	:	MONROE
State	:	NC
Zip	:	28112-5266
Country	:	US
Telephone Number	:	704-283-6953
Fax Number	:	704-283-0228

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/20/2009

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