Healthcare Provider Details

I. General information

NPI: 1770571937
Provider Name (Legal Business Name): RAKESH GULATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST SUITE 700
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 700
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-3000
  • Fax: 215-503-4099
Mailing address:
  • Phone: 215-503-3000
  • Fax: 215-503-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD062663L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: