Provider Demographics
NPI:1992811376
Name:RAO, RAJU (MD)
Entity type:Individual
Prefix:
First Name:RAJU
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 1:201 S 68TH STREET PL STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2496
Mailing Address - Country:US
Mailing Address - Phone:402-420-7000
Mailing Address - Fax:402-420-7240
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-420-7000
Practice Address - Fax:402-420-7240
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE196242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47079130413Medicaid
NE920001998OtherRAILROAD MEDICARE
NE47079130413Medicaid
D95262Medicare UPIN