Provider Demographics
NPI:1538131297
Name:RAO, GAYATHRI SUDHAKAR (MD)
Entity type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:SUDHAKAR
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:NEMOURS DUPONT PEDIATRICS, COLLEGEVILLE
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3954
Practice Address - Country:US
Practice Address - Phone:302-651-6660
Practice Address - Fax:302-651-5345
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD040876E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA10934628Medicaid
PA10934628Medicaid
PA156676HK1Medicare PIN