Healthcare Provider Details

I. General information

NPI: 1639120645
Provider Name (Legal Business Name): JACOB R RACHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

1101 BEACON ST
BROOKLINE MA
02446-5587
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-8334
  • Fax: 617-731-8556
Mailing address:
  • Phone: 617-731-8334
  • Fax: 617-731-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number74738
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number74738
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: