Healthcare Provider Details

I. General information

NPI: 1649774696
Provider Name (Legal Business Name): RACHEL WILTJER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MANN

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S. PACA ST 6TH FLR SUITE 200
BALTIMORE MD
21201
US

IV. Provider business mailing address

250 W PRATT ST STE 900
BALTIMORE MD
21201-6808
US

V. Phone/Fax

Practice location:
  • Phone: 732-593-7618
  • Fax:
Mailing address:
  • Phone: 667-214-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH0097602
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH0097602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: