Provider Demographics
NPI:1013363829
Name:RAO, PAVAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 7011B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8275
Mailing Address - Country:US
Mailing Address - Phone:314-251-6840
Mailing Address - Fax:314-251-7249
Practice Address - Street 1:621 S NEW BALLAS RD STE 7011B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8275
Practice Address - Country:US
Practice Address - Phone:314-251-6840
Practice Address - Fax:314-251-7249
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025014653208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery