Provider Demographics
NPI:1861586877
Name:RAO, SHAHNAZ K (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:K
Last Name:RAO
Suffix:
Gender:F
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:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-0292
Mailing Address - Country:US
Mailing Address - Phone:410-670-8080
Mailing Address - Fax:410-670-8054
Practice Address - Street 1:14300 GALLANT FOX LN STE 224
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4033
Practice Address - Country:US
Practice Address - Phone:410-670-8080
Practice Address - Fax:410-670-8054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010592208M00000X
MDD0073996207RS0012X
CT49053207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511315600Medicaid