Individual
MR. MARK R RAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
104 ENDICOTT ST., LL05, DANVERS, MA 01923
(978) 739-7700
(978) 739-7736
Mailing address
NSPG 104 ENDICOTT ST, DANVERS, MA 01923
(978) 739-7700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-733
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265428759
—
ME
Enumeration date
09/21/2005
Last updated
10/30/2018
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