Healthcare Provider Details

I. General information

NPI: 1669466595
Provider Name (Legal Business Name): RADHIKA RACHAMALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL DYSON CENTER 2ND FLOOR
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

1351 ROUTE 55 SUITE 200
LAGRANGEVILLE NY
12540-5108
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-6960
  • Fax: 845-483-6425
Mailing address:
  • Phone: 845-475-9661
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number233018
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number233018
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number233018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: