Healthcare Provider Details

I. General information

NPI: 1912153792
Provider Name (Legal Business Name): MICHAEL RACHSHTUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MD ANDERSON CANCER CENTER 2 COOPER PLAZA
CAMDEN NJ
08103
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 855-632-2667
  • Fax:
Mailing address:
  • Phone: 856-356-4924
  • Fax: 856-356-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD427270
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA08080500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA08080500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: