Individual
GAUTAM RAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 S GREENE ST, SUITE S3AX-19, BALTIMORE, MD 21201-1544
(667) 214-1302
(410) 328-3379
Mailing address
250 W PRATT ST, SUITE 880, BALTIMORE, MD 21201-2423
(667) 214-1302
(410) 328-3379
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
D72905
MD
207VX0201X
Gynecologic Oncology Physician
MD39934
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4164064
BCBS TN
TN
05
—
440080100
—
MD
Enumeration date
10/25/2006
Last updated
05/31/2016
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