Basic Information
| Provider Information | |||||||||
| NPI: | 1669415592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | INNANJE | ||||||||
| MiddleName: | RAVINDRANATH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60122 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045124808 | ||||||||
| FaxNumber: | 7045124838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1423 E FRANKLIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042836953 | ||||||||
| FaxNumber: | 7042830228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 19943 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 267168 | 05 | SC | MEDICAID | 70415 | 01 | NC | BCBS | OTHER | P00612312 | 01 | NC | RAILROAD MEDICARE | OTHER | 8970415 | 05 | NC | MEDICAID |