Healthcare Provider Details

I. General information

NPI: 1043876394
Provider Name (Legal Business Name): RACHEL K BOOTH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE STE 300
CENTERVILLE OH
45459-7021
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-4850
  • Fax: 937-848-4858
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number58.031130
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: