Provider Demographics
NPI:1841392800
Name:RAO, GUNJAN (MD)
Entity type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
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 1:88 MORGAN ST APT PH1-1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1427
Mailing Address - Country:US
Mailing Address - Phone:857-225-2421
Mailing Address - Fax:
Practice Address - Street 1:9 MCWILLIAMS PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1609
Practice Address - Country:US
Practice Address - Phone:212-226-7666
Practice Address - Fax:212-202-7988
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09529900208000000X
CT048898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
055141Q09Medicare ID - Type Unspecified
H55395Medicare UPIN
PA0018833150002Medicaid