Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 111528 | NY |
N | 2080A0000X | Adolescent Medicine | 111528 | NY |
NPI | 1225146574 |
---|---|
Provider Name | Dr. Govind C K Rao |
First Address | Amsterdam, NY 12010 |
Second Address | Amsterdam, NY 12010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 20/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00515077 | (05) | NY |
B80156 | (02) | NY |