Healthcare Provider Details

I. General information

NPI: 1356338917
Provider Name (Legal Business Name): ALAN RAUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE MC 7
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE MC 7
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-6696
  • Fax: 518-262-6770
Mailing address:
  • Phone: 518-262-6696
  • Fax: 518-262-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number139657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: