Healthcare Provider Details

I. General information

NPI: 1396934436
Provider Name (Legal Business Name): SRILATHA RACHAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTENNIAL BLVD STE 202
VOORHEES NJ
08043-4637
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6770
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax: 732-790-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD430785
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0012315
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA08316300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08316300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: