Provider Demographics
NPI:1235500562
Name:RAO, RAJESH GADE (PA-C)
Entity type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:GADE
Last Name:RAO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2928
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2928
Mailing Address - Country:US
Mailing Address - Phone:425-207-5155
Mailing Address - Fax:
Practice Address - Street 1:11995 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97015-9312
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:971-282-0083
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant