Healthcare Provider Details

I. General information

NPI: 1811842982
Provider Name (Legal Business Name): ALEXANDER DANIEL RAUCCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4893
US

IV. Provider business mailing address

1616 WALNUT ST APT 2104
PHILADELPHIA PA
19103-5317
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: