Healthcare Provider Details

I. General information

NPI: 1851747265
Provider Name (Legal Business Name): RACHAEL KUCH-CECCONI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHAEL KUCH

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3733
  • Fax:
Mailing address:
  • Phone: 315-464-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number306469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: