Healthcare Provider Details

I. General information

NPI: 1396774279
Provider Name (Legal Business Name): ILANA RACHSHTUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 KUTZTOWN RD
KUTZTOWN PA
19530-9275
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 610-683-7393
  • Fax: 610-683-5470
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD420930
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: