Healthcare Provider Details

I. General information

NPI: 1750318739
Provider Name (Legal Business Name): RAKESH MASHRU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 403
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-3113
  • Fax: 856-541-5379
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA09484800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: