Provider Demographics
NPI:1174618805
Name:RAO, NEERAJA (PAC)
Entity type:Individual
Prefix:
First Name:NEERAJA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PALADIN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7826
Mailing Address - Country:US
Mailing Address - Phone:252-752-8880
Mailing Address - Fax:
Practice Address - Street 1:511 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-752-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2752800Medicare ID - Type Unspecified
NCR39705Medicare UPIN